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Weekly Chest CasesArchive of Old Cases

Case No : 1140 Date 2019-09-01

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  • Courtesy of So Youn Shin, Dong Wook Sung / Kyung Hee University Hospital
  • Age/Sex 65 / M
  • Chief Complaintchest PA abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Schwannoma
Radiologic Findings
Fig 1-2. Chest plain radiographs show mass in left lower lobe posterior portion.
Fig 3-6. On enhanced chest CT, about 4.8 x 3.5 cm sized, well-defined mass in left lower posterior hemithorax. The mass shows obtuse angle with the pleura and heterogeneous enhancement without accompanying rib destruction abutting with the mass.
Brief Review
Thoracic neurogenic tumors can originate from any nervous structure within the chest and are derived from cells of the autonomic ganglia, paraganglia or nerve sheath. The most common type of such nerve sheath tumors are Schwannomas, which originate from the spinal nerve root and extending along the intercostal nerve. Histologically, schwannomas consist of Schwann cells arranged in either a highly cellular distribution (Antoni A) or in a loose myxoid component (Antoni B), but both types may also be present in a single schwannoma.
Chest radiography of Schwannomas generally shows a smoothly marginated, oval paraspinal mass. In particular, contrast-enhanced CT shows a well-marginated paraspinal soft tissue mass with a possible split fat sign (fat attenuation around the soft-tissue mass). This is caused by displaced but intact surrounding fat covering the neuromuscular bundle, indicative of a non-filtrating underlying neurogenic mass. Schwannomas may also contain areas of low attenuation corresponding to fat or cystic degeneration. Calcification is seen in about 10% of Schwannoma cases, which may primarily be in a peripheral pattern, particularly in long-standing lesions with advanced degeneration. Osseous pressure erosion may also be present.
Meanwhile, MRI of Schwannomas cases shows low to intermediate signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and intense enhancement of solid components on gadolinium-enhanced imaging.
Please refer to
Case 120, Case 415, Case 1129,
References
1. Woo OH, Yong HS, Shin BK, OhYW, Kim HK, Kang EY. Wide spectrum of thoracic neurogenic tumours: a pictorial review of CT and pathologic findings. Br J Radiol 2008; 81:668-676.
2. Pavlus JD, Carter BW, Tolley MD, Keung ES, Khorashadi L, Lichtenberger JP 3rd. Imaging of thoracic neurogenic tumors. AJR 2016; 207:552-561.
3. Geniets C, Vanhoenacker FM, Simoens W, Gielen J, De Schepper AM, Parizel PM. Imaging features of peripheral neurogenic tumors. JBR-BTR 2006; 89:216
Keywords
pleura, intercostal neurogenic tumor, schwannoma ,

No. of Applicants : 66

▶ Correct Answer : 18/66,  27.3%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Affilitated Hospital of Jining Medical University , China HUA SHENG JIANG
  • - , Korea (South) CHOHEE KIM
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Other , Korea (South) JUWON KIM
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Japan NAOMI YUASA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - , Japan SOTA MASUOKA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
▶ Correct Answer as Differential Diagnosis : 23/66,  34.8%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Seoul National University Bundang Hospital , Korea (South) SOWON JANG
  • - St. Lukes International Hospital , Japan DAISUKE YAMADA
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) MIN A LEE
  • - , Korea (South) JANG SEONG WON
  • - , Taiwan NING CHIEN
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan YUMI MAEHARA
  • - Shaanxi Forest Industry Hospital , China GUO JIAN WEI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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