대한흉부영상의학회 Korean Society of Thoracic Radiology GuerBet

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Weekly Chest CasesArchive of Old Cases

Case No : 799 Date 2013-02-18

  • Courtesy of Kun Young Lim, Hyae Young Kim, Soo Hyun Lee / National Cancer Center, Korea
  • Age/Sex 47 / M
  • Chief ComplaintAbnormality on chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Intrathoracic Gossypiboma
Radiologic Findings
Chest radiograph shows a mass in left lower hemithorax. Contrast enhanced CT scans show a heterogenous attenuation mass with internal high density at left lower pleural space. PET-CT shows increased FDG uptake on the peripheral rim of the mass with low central uptake. The patient has a history of left upper lobe volume reduction surgery thirteen years ago.
Brief Review
The mass had a thick, fibrous capsule and contained gauze and necrotic material inside(Fig). Clinical and radiological appearances of intrathoracic gossypiboma are variable, depending on the location and chronicity of the retained sponge. Two frequent sites of intrathoracic gossypiboma are the pleural and pericardial cavities.
The plain radiograph usually reveals an unusual opacity or an atypical mass in the chest that generally does not change over time. The typical CT feature is a well-defined mass with central air bubbles and a hyperdense, well-enhancing rim in the early postoperative period. However, because trapped air is resorbed with time, lesions cannot be differentiated from other solid masses in the late postoperative period. PET/CT shows an intrathoracic gossypiboma as a mass with low central uptake in relation to the actual gauze and a external capsule with a high level of FDG activity secondary to the fibroblastic content.
References
1.Manzella A, Filho PB, Albuquerque E, et al. Imaging of Gossypibomas: Pictorial Review. AJR 2009;193:S942.
2.Suwatanapongched T, Boonkasem S, Sathianpitayakul E, et al. Intrathoracic gossypiboma: radiographic and CT findings. The British Journal of Radiology 2005; 78: 851
Please refer to
Case 634 Case 57
Keywords
Lung, Non-infectious inflammation, Postoperative complication,

No. of Applicants : 88

▶ Correct Answer : 2/88,  2.3%
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - IRSA La Rochelle France , France Denis Chabassiere
▶ Correct Answer as Differential Diagnosis : 3/88,  3.4%
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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