Weekly Chest CasesImaging Conference Cases

Case No : 7

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  • Age/Sex 39 / F
  • Case Title 39-year-old woman with an abnormality on routine chest radiograph
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Diagnosis With Brief Discussion

Courtesy
K
Discussion
-Most patients are between 45 and 65 years, without significant sex difference. Most (up to 3/4) arise from visceral pleura. Pedunculation is present in about 50%.

-On microscopic examination, the lesion consists of spindle-shaped cells seperated by collagen. It exists in benign and malignant forms; 14% to 30% are malignant.

-In about half the patients the tumor is asymptomatic and detected incidently on chest radiograph. The most common symptoms are cough, chest pain, and dyspnea. Hypertrophic osteoarthropathy is reported in 4% to 12% of patients. Symptomatic hypoglycemia is seen in up to 6% of patients.

-On chest radiograph, the usual finding is a slow-growing, oval, often lobulated, homogeneous mass in contact with pleura. The lesions vary in size from less than 1 cm to 30 cm but usually large when initially detected. Tumors on pedicles may change in shape and position on different occasions and in different postures.

-On CT the lesions are usually well defined, based on a pleural surface. On contrast-enhanced CT, inhomogeneous enhancement is a frequent feature due to mixed areas of hemorrhage, cyst, myxoid change and soft tissue elements. Calcification is infrequently present.

-On T1-weighted MR images, tumors showed low signal intensity. Tumors had heterogeneous signal intensity on T2-weighted images. After IV administration of gadolinium, soft tissue elements of tumors are well enhanced.
Keywords
Pleura, Benign tumor,
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