대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1292 Date 2022-07-29

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  • Courtesy of Junwoo Kim / Bundang Seoul National University Hospital
  • Age/Sex 73 / M
  • Chief ComplaintHemoptysis (2 MA), left flank pain (5 MA) # history of pulmonary TB
  • Figure 1
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  • Figure 3
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  • Figure 5
  • Figure 6
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  • Figure 9

Diagnosis With Brief Discussion

Diagnosis
Chest wall angiosarcoma
Radiologic Findings
Fig 1. Chest PA shows a mass-like lesion in the left middle to lower lung zone with calcification.
Fig 2-5. CT scan reveals a chronic empyema in the left lower hemithorax. In addition to chronic empyema, there is an infiltrative heterogeneous mass in the left chest wall with invasion to the left 5th rib. Consolidation in the LUL was also noted, which were probable aspiration-related findings.
Fig 6-9. PET scan shows hypermetabolism in the mass periphery and adjacent structures.
Brief Review
Annual incidence of AS is probably 0.01 to 0.02 per 100,000 population. Meanwhile, there was an incidence rate of pyothorax-associated angiosarcoma among chronic pyothorax patients of 0.036 per 100 patients. Thus, the frequency rate of pyothorax-associated AS is supposedly over 3600-fold higher than that in normal population. The present study shows that chronic tuberculous pyothorax is one of the causes of AS development.

At multidetector CT, angiosarcomas are heterogeneous with internal regions of necrosis, hemorrhage, and vascularity. After intravenous administration of contrast material, enhancement of the vascular tissue may be seen.
At MR imaging, the typical finding is a soft-tissue mass with heterogeneous signal intensity on T1- and T2-weighted images. Intense enhancement following the intravenous administration of gadolinium-based contrast material is common.
Discrete vessels may be identified at the tumor periphery.
At FDG PET/CT, angiosarcoma demonstrates increased FDG uptake, although the uptake pattern may be heterogeneous owing to the presence of hemorrhage and/or necrosis.
References
Angiosarcoma developing from chronic pyothorax. Mod Pathol. 1994 Dec;7(9):906-11
Carter, B. W., Benveniste, M. F., Betancourt, S. L., de Groot, P. M., Lichtenberger, J. P., Amini, B., & Abbott, G. F. (2016). Imaging Evaluation of Malignant Chest Wall Neoplasms. RadioGraphics, 36(5), 1285
Keywords
Chest wall angiosarcoma ,

No. of Applicants : 91

▶ Correct Answer : 4/91,  4.4%
  • - , Japan HIROAKI ARAKAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
▶ Correct Answer as Differential Diagnosis : 11/91,  12.1%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - Osaka University , Japan AKINORI HATA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 41/91,  45.1%
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - , Italy PAOLO BALDASSARI
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - , China FANG YING GEN
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Other , Korea (South) HYEON IL CHOI
  • - , Korea (South) HYUNSEUNG LEE
  • - Japanese Red Cross Medical Center , Japan YASUSHI AOYAGI
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Yamanashi Prefectural Hospital , Japan HIROAKI WATANABE
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - , United Arab Emirates NEHAR RANJAN CHAKRABORTY
  • - Other , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - TB centre kasaragod. , India rikhy krishnan
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Chonnam Hospital , Korea (South) JAEHYUN PARK
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - , Japan YUMI MAEHARA
  • - Govt. Kilpauk Medical College, Chennai , India VIGNESH K
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