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Weekly Chest CasesArchive of Old Cases

Case No : 563 Date 2008-08-11

  • Courtesy of Dae Wook Yeh, MD, Kyung Soo Lee, MD. / Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
  • Age/Sex 63 / M
  • Chief ComplaintRight upper chest wall mass / onset : 1yr ago / discomfort (+) but no pain
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Chondrosarcoma
Radiologic Findings
Posteroanterior and left lateral chest radiographs show right anterior chest wall mass.
Contrast enhanced axial CT images show a low attenuation mass replacing right 2nd rib and costal cartilage.
The mass contains chondroid mineralization.
CT scans also demonstrate multiple mediastinal lymphadenopathy and pleural metastasis.
Brief Review
The vast majority of solitary lesions (not associated with enchondromatosis) with chondroid matrix mineralization in the ribs and sternum are chondrosarcomas, and solitary enchondromas are extremely rare. Occasionally, chondrosarcomas in the ribs and sternum may be discovered incidentally at chest radiography. Patients are often somewhat younger than those with conventional chondrosarcomas in other sites. Rib lesions usually involve the anterior rib at the costochondral junction and show osseous expansile remodeling with a ring-and-arc pattern of calcification and soft-tissue extension on both radiographs and CT.

The soft tissue component frequently reveals typical punctuate or ring-and-arc matrix mineralization and a lobular growth pattern. The nonmineralized components, both intraosseous and extraosseous, typically have low attenuation on CT scans, reflecting the high water content of hyaline cartilage. CT performed after intravenous administration of contrast material demonstrates mild peripheral rim and septal enhancement. Higher-grade lesions may show higher CT attenuation, similar to that of muscle, and more prominent diffuse or nodular contrast enhancement, caused by increased cellularity and resultant reduced water content.
References
RadioGraphics 2003; 23:1245?278
Keywords
Chest wall, Malignant tumor,

No. of Applicants : 77

▶ Correct Answer : 28/77,  36.4%
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - McGill University Health Centre , Canada Amr Ajlan
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - CHRU lille , France manuel toledano
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India , India Bankim Amin
  • - KMC,Manipal , India satish maddukuri
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - Hanmaeum Hospital , Korea (South) Kwon Kim
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - EKH-Berlin , Germany Holger Hartmann
  • - apollo hospitals , India harish bhambore
  • - Lilavati hospital and Research center , India vivek gupta
  • - Apollo Hospital, Ahmedabad. , India Sandip Shah.
  • - Pe d , France Fabrice Bing
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Al-Hada Armed Forced Hospital , Saudi Arabia Ahmed Eid
  • - soonchunhyang university hospital, Bucheon , Korea (South) Park jisang
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
▶ Correct Answer as Differential Diagnosis : 22/77,  28.6%
  • - Cheongshim international medical center , Korea (South) Yang Hae Jum
  • - jaslok hospital mumbai , India jainendra jain
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - BOLLINENI HOSPITAL NELLORE , India jignesh dubal
  • - baghdad , United Arab Emirates fahad al-hamidi
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - Kashan University of Medical Sciences, kashan, Iran , Iran Ebrahim Razi
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Tri-Service General Hospital , Taiwan Tsun-Hou Chang
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Regional Imaging Ltd. - Riverina, NSW , Australia Rashid Hashmi
  • - chp st martin , France Mariotte benoit
  • - MEDINOVA DIAGNOSTICS , India Harsha NS
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Semi-Correct Answer : 3/77,  3.9%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
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