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Weekly Chest CasesArchive of Old Cases

Case No : 759 Date 2012-05-15

  • Courtesy of Mi-Jin Kang / Inje Uiversity Sanggye Paik Hospital
  • Age/Sex 51 / M
  • Chief ComplaintAbnormal finding on chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Solitary fibrous tumor of the pleura
Radiologic Findings
Fig 1. Chest PA shows oval, well defined increased opacity in left lower lung zone, making double cardiac contour.
Fig 2. Chest lateral view shows increased opacity, in the lower substernal area.
Fig 3-5. Chest CT scan show well defined oval mass with moderate in left anterior mediastinum, abutting the left cardiac border. an attenuation vale of the mass was 60 HU after contrast media administration, and 30 HU before contrast media administration. Note part of mass project into the LUL, suggesting pedicle arising form left anterior hemithorax.
Fig. 6. Gross specimen shows well defined pedunculated mass arising from anterior costal pleura.

Figure 6

Brief Review
Solitary fibrous tumors are rare primary pleural neoplasms that may grow to large sizes and typically affect symptomatic men and women over the age of 40 years.
Small solitary fibrous tumor of pleura without gross necrosis, hemorrhage, or cystic change may exhibit homogeneous attenuation on unenhanced and less frequently on contrast-enhanced chest CT scans. However, the majority of solitary fibrous tumor of pleura exhibit heterogeneous attenuation on CT scans, characterized as intralesional geographic, focal or linear areas of low attenuation that often correlate with hemorrhage, necrosis, or cystic changes. Calcification may occur in one-fourth of cases. Atelectasis of the adjacent lung and mass effect on the mediastinum are common associated findings.
Enhancement may correlate with the vascular nature of these lesions and may result in higher attenuation than that of other soft tissues in the thorax. Lee and colleagues studied nine cases of LFTP with CT and demonstrated significant enhancement in all. Enhancement is typically heterogeneous (particularly in large lesions) with central areas of low attenuation, which have been shown to correlate with myxoid change, hemorrhage, necrosis, or cystic degeneration.
References
1. Rosado-de-Christenson ML, Abbott GF, McAdams HP, Franks TJ, Galvin JR. From the Archives of the AFIP: Localized Fibrous Tumors of the Pleura. Radiographics 2003; 23:759-783.
2. Lee KS, Im JG, Choe KO, Kim CJ, Lee BH. CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients. AJR Am J Roentgenol 1992; 158:983-986.
3. Francis IR, Dorovini-Zis K, Glazer GM, Lloyd RV, Amendola MA, Martel W. The fibromatoses: CT-pathologic correlation. AJR Am J Roentgenol 1986; 147:1063-1066.
Keywords
pleura, malignant tumor,

No. of Applicants : 88

▶ Correct Answer : 14/88,  15.9%
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Korea Uivercity Medical Center , Korea (South) Euddeum Shim
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Saga University , Japan Ryoko Egashira
  • - Chungbuk National University Hospital , Korea (South) Su Jeong Hyun
  • - Gangnam Severance Hospital , Korea (South) Yoon, young-no
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - CHRU Lille , France Paul Lebert
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Korea university anam hospital , Korea (South) Sung-Hye You
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 25/88,  28.4%
  • - radiologist, aditya imaging centre , India vivek patel
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - chp st martin , France Mariotte benoit
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Travancore Medical College , India Chary D
  • - MASAN , Korea (South) Kim Sang Hyeon
  • - SNUH , Korea (South) Euijin Hwang
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Montreal , Canada Drago Le King
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - HIA Legouest - METZ , France Alban Gervaise
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - NASA SCANS , India RAKESH BHATIA
  • - Private sector , Greece Vasilios Tzilas
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
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