Chest Wall Swelling Research Articles

Persistent pleural tuberculosis presenting as chest wall swellings in an immunocompetent patient: A rare case report in a low resource setting

Persistent pleural tuberculosis presenting as chest wall swellings in an immunocompetent patient: A rare case report in a low resource setting

Spondyloarthritis and Tietze's syndrome: A Re-evaluation.

Spondyloarthritis comprises a number of related but different disorders with distinct phenotypes: psoriatic arthritis, reactive arthritis, arthritis related to inflammatory bowel disease, undifferentiated arthritis, and ankylosing spondylitis (the well-known prototypic subtype). Differentiating rheumatic diseases, such as rheumatoid arthritis, synovitis-acne-pustulosis-hyperostosis-osteitis syndrome, pustulotic arthro-osteitis, gout and spondyloarthritis, is difficult because they all may manifest swelling at the upper anterior chest wall, often involve the sternocostal and/or sternoclavicular joints, and clearly show cutaneous nodular symptoms, so that they may mimic Tietze's syndrome in the presentation. Tietze's syndrome is a benign, self-limiting entity with tender, non-suppurative swelling in the upper anterior chest wall, especially at the second and third costosternal junctions and the sternoclavicular joint. Therefore, distinguishing spondyloarthritis from Tietze's syndrome during an entire disease course is important, even after an initial tentative diagnosis. This article aims to re-evaluate the importance of Tietze's syndrome in the differential diagnosis of spondyloarthritis, while keeping in mind information about rheumatic diseases affecting the upper anterior chest wall.

An innovative reconstruction of an enbloc resected composite giant chest and abdominal wall chondrosarcoma with 3D-composite mesh

BackgroundChest wall chondrosarcomas, although common, pose unique challenges due to their aggressive nature, rarity of abdominal wall involvement, and propensity for recurrence. We highlight the critical role of meticulous surgical planning, multidisciplinary collaboration, and innovative reconstruction techniques in achieving optimal outcomes for patients with composite giant chest and abdominal wall chondrosarcoma.Case PresentationA 38-year-old female patient presented with progressive left chest and abdominal wall swelling for two years; on evaluation had a large lobulated lytic lesion arising from the left ninth rib, scalloping eighth and tenth ribs measuring 13.34 × 8.92 × 10.71 cm (anteroposterior/transverse/craniocaudal diameter) diagnosed with chondrosarcoma grade 2. A three-dimensional (3D) composite mesh was designed based on computed tomography using virtual surgical planning and computer-assisted design and manufacturing technology. She underwent wide local excision and reconstruction of the chest and abdominal wall with 3D-composite mesh under general anesthesia. The postoperative condition was uneventful, with no recurrence at 12 months follow-up.ConclusionA 3D-composite mesh facilitates patient-specific, durable, and cost-effective chest and abdominal wall reconstruction.

Tuberculous Mediastinitis with Mediastinal Abscess in an Immunocompetent Man Presented with Fever, Acute Dyspnoea, Chest Pain, Chest Wall Swelling, Acute Kidney Injury, Transaminitis and DIC: Rare Case Report

Tuberculous Mediastinitis with Mediastinal Abscess in an Immunocompetent Man Presented with Fever, Acute Dyspnoea, Chest Pain, Chest Wall Swelling, Acute Kidney Injury, Transaminitis and DIC: Rare Case Report

Resection of a rapidly growing chest wall cyst: a case report

BackgroundWhen cystic lesions are detected in the chest wall, postoperative seroma and abscesses can be considered in the differential diagnoses. Herein, we present a case of a large chest wall cyst with rapid growth 5 years after thoracic surgery.Case presentationA male patient in his 60s was admitted to our hospital complaining of a rapidly enlarging chest wall swelling. He underwent a pleural biopsy for pleural thickening and was diagnosed with pleurisy 5 years ago. Computed tomography revealed a cystic lesion with a capsule measuring 14 cm × 10 cm, and contrast-enhanced magnetic resonance imaging revealed a heterogeneous enhancement effect inside the lesion. Surgical resection was performed for definitive diagnosis and therapeutic purposes. Intraoperatively, a cystic lesion with a thick capsule located outside the thorax was seen. The lesion was resected completely with no remaining adherence to the surrounding tissues and muscles. Histopathological examination revealed that the cyst wall was a non-epithelial fibrous connective tissue with inflammatory cell infiltration, and the contents were viscous liquid and fibrin, suggestive of a chest wall cyst. The cyst wall had abundant CD34-positive vascular endothelium, suggestive of rapid enlargement due to the influx of exudate associated with angiogenesis. No recurrence was observed 1 year postoperatively.ConclusionsIn addition to bacteriology, pathological examination, including immunohistological examination, is useful for the differential diagnosis of chest wall cystic lesions.

Localised plasmacytoma presenting as right chest wall swelling

Development of any swelling in the right lower chest wall or right upper abdomen is an unusual presentation. Hence the localisation of the origin of swelling becomes difficult to ascertain through clinical examination alone. Accurate diagnosis requires detailed investigation and ruling out of differentials one by one. We would like to share one such case of a patient presenting to surgery OPD with complaint of swelling in the lateral aspect of right chest wall which on investigations turned out to be a rib tumour arising from the bone marrow. Lady of age 57 years presented to us with h/o swelling in lateral aspect of right chest wall which gradually increased in size over 3 years and associated with pain for last 5 months. On exam an oval swelling of size 8×5 cm seen in lateral wall of right lower chest wall. On detailed investigations, the swelling was diagnosed as a plasma cell tumour of right 8th rib. Any chest wall or abdominal swelling needs detailed evaluation before proceeding for surgical intervention. It is important to keep various differential diagnosis in mind considering clinical factors and site of swelling to make an accurate diagnosis.

Myocysticercosis presenting as an uncommon cause of chest wall swelling: A case report

Cysticercosis is a common helminthic parasitic infection in humans caused by larva of Taenia solium. It most commonly affects the brain causing neurocysticercosis. It also affects the different system of the body as eyes, subcutaneous tissue, eye, lungs. Diagnosis of cysticercosis is usually done by imaging such as ultrasound for cutaneous, muscular and orbital infection whereas CT scan for the neuro cysticercosis. We report a case of myocysticercosis on lateral chest wall of the 7-year-old male from a rural region of Nepal.

Thoracic lipoblastoma in a 7-month-old infant.

We report a rare case of a thoracic lipoblastoma in a 7-month-old infant who presented with respiratory infection, dyspnea, and a right-sided chest wall swelling. Imaging revealed a predominantly fatty mass, and biopsy confirmed the diagnosis. A right thoracotomy was performed, resulting in subtotal excision due to the tumor's friability. Two months later, a recurrent tumor was detected and was successfully treated with total excision. This case emphasizes the importance of complete surgical resection and regular follow-up to prevent local recurrence of thoracic lipoblastoma.

Hepatocellular carcinoma presenting as a chest wall mass - An unusual case diagnosed on cytology with review of literature.

Hepatocellular carcinoma (HCC) is associated with an aggressive behavior and a strong tendency for extrahepatic metastasis. Although 5%-15% patients have metastases at diagnosis, presentation with symptoms exclusively related to extrahepatic metastases is rare. An 82-year-old male presented with an isolated left anterolateral chest wall swelling. Ultrasonography revealed a soft tissue mass involving the anterior chest wall with adjacent rib erosion. Serum protein electrophoresis showed increase in beta-2 region. A clinical diagnosis of multiple myeloma was considered. Fine needle aspiration cytology from the swelling showed loosely cohesive clusters of polygonal cells with traversing blood vessels. Cells showed abundant vacuolated to granular cytoplasm, round nuclei with frequent intranuclear cytoplasmic inclusions. A differential of metastatic HCC and renal cell carcinoma was considered. Subsequent imaging showed a 12 cm mass in the liver. Biopsy from chest wall mass with immunohistochemistry confirmed the diagnosis. Lungs and lymph nodes are the commonest sites for metastatic HCC; presentation as chest wall metastasis is rarely reported. The classical cytomorphology of HCC proved useful in diagnosing metastasis at a rare site. Recent studies have shown that beta-2-globulin is a promising biomarker for early diagnosis of HCC in patients with chronic liver disease.

Encapsulated Papillary Carcinoma of The Breast: A Case Report of Rare Male Breast Cancer Clinically Presented as Soft Tissue Tumor

BACKGROUND: Male breast cancer is a rare condition, accounting for less than 1% of all breast cancers, and infiltrating ductal carcinoma is the most common type. However, Encapsulated Papillary Carcinoma (EPC) in males is a rare type of breast cancer, and the exact etiology is unknown. CASE REPORT: A 66-year-old male presented with a 15x10 cm mobile swelling over the left side of the anterior chest wall, which was clinically and radiologically diagnosed as a soft tissue tumor. Wide local excision of the swelling of the anterior chest wall was performed. Grossly, it was an encapsulated tumor with solid and cystic areas filled with gelatinous material, papillary excrescences, hemorrhage, and necrosis. Microscopic examination revealed Grade 2 encapsulated papillary carcinoma of the left breast. CONCLUSION: This case report highlights the importance of considering male breast cancer as a differential diagnosis in patients presenting with anterior chest wall soft tissue swelling. Keywords: Male breast cancer, encapsulated papillary carcinoma, anterior chest wall swelling.

Diffuse large B-cell lymphoma presenting as sternal mass in a patient with ankylosing spondylitis: a case report study.

The authors present a rare case of primary diffuse large B-cell lymphoma of the sternum in a 41-year-old Iranian woman with ankylosing spondylitis (AS). Physical examination revealed a 7×7.5cm firm swelling of the anterior midline chest wall above the breasts, and MRI showed a lesion within the sternal marrow with an associated soft-tissue mass in the anterior aspect of the sternum. Following core-needle biopsy under ultrasound guidance, a histopathological study demonstrated diffuse sheets of large noncleaved atypical cells with large multilobated prominent nuclei and fine chromatin compatible with diffuse large B-cell lymphoma. Primary and exclusive involvement of the sternum is an uncommon presentation of lymphoma. Radiological, histological, and clinical characteristics of primary bone lymphoma can resemble those of other medical disorders. Although infrequent, existing evidence shows that AS seems to be associated with a small but significant risk for malignancy. Even though inflammatory involvement of the anterior chest wall could be a common clinical finding in patients with AS, it is recommended that anterior chest wall pain or any mass almost always needs comprehensive assessment and imaging evaluation in such patients to avoid any delayed diagnosis, misdiagnosis, and ensuing morbidity or mortality.

Empyema Necessitans Secondary to Tuberculosis: A Case Report

Empyema necessitans (EN) is a sporadic disease in the 21st century. It is a condition where the empyema has diffused and is loculated in the extrapleural space. It is usually caused by Tuberculosis (TB) infection or immunocompromised condition. Its manifestation, which is often vague in the beginning, leads to diagnostic dilemmas and delays in management. This has considerably affected patients adversely and incurred avoidable healthcare costs. We describe a rare case of empyema necessitans secondary to pulmonary tuberculosis in a 43-year-old male who presented to the emergency department with right anterior chest wall swelling, which was associated with pain, lethargy, malaise and significant loss of weight. Targeted ultrasonography of the anterior chest wall revealed a right anterior chest wall collection with intrathoracic extension. Contrast-enhanced computed tomography of the chest showed a multiloculated right chest wall collection with intrathoracic extension. Percutaneous drainage of the collection was performed, and the pus sent for Mycobacterium tuberculosis culture was positive. This case highlights the importance of a high index of suspicion and clinical awareness for this dangerous and silent disease.

Post therapeutic changes in various malignancies

Background: Neo adjuvant Radiotherapy and chemotherapy can cause significant changes in the gross and microscopic appearance of malignant tissues and normal surrounding tissues. Since radiotherapy is now offered to a large number of cancer patients, pathologists are more frequently presented with such changes. Both epithelial and stromal changes can be present. Epithelial changes in the form of atrophy, apoptosis, necrosis, dysplasia and neoplasia, while stromal changes the form of fibrosis, exudates, necrosis, pattern of invasion and vessel wall thickness. These changes may interfere with recognition of microscopic residual tumor if present. With increasing use of radiation therapy in cancer treatment and longer survival of patients, assessment of radiation-associated changes in tissues and tumours has become an important issue in modern pathology.Materials and Methods: The present study was carried out on 50 patients. Type of samples includes cytological smears and histopathological specimens received in respective cytopathology and histopathology section of the pathology department after any chemotherapy or radiotherapy.Objective1.To study cyto-morphological changes after chemotherapy and/or radiotherapy. 2.To differentiate secondary malignancy from radiation damage.Results: The present study was carried out on 50 patients including 13 patients with lymph node metastasis,12 cases with head & neck region, 2 scrap smear, 9 anterior chest wall swelling, 3 cases of liver, 5 cases of lung,1 plural fluid and 5 cases of breast. The effects have been divided mainly into two, as pathological changes in tumor cells and changes in the stroma.Conclusion: It is concluded from the findings of present study that various nuclear abnormalities reveal a statistically significantly increases with increasing chemoradiation doses and time interval. Post neoadjuvant chemotherapy, specimens revealed nuclear enlargement, nuclear shrinkage, necrosis, vacuolation of nucleus, vacuolation of cytoplasm, dyscohesion, and shrinkage of tumor cells with nuclear changes of nonviability like karyorrhexis, karyolysis, and pyknosis. Stromal reactions manifested as fibrosis, elastosis, collagenization, hyalinization, microcalcification, and neovascularization. Areas of necrosis included both vascular and avascular pattern. The stroma also revealed fibrinoid necrosis and mucinous change. Hyalinization of the blood vessel wall was a common finding.

Tubo-ovarian mass with raised CA-125 in a 21-year-old female

IntroductionPeritonitis associated with fungal species Curvularia lunata seldom occurs with only five cases reported in the literature, all in middle-age patients with comorbidities undergoing dialysis.Case reportA 21-year-old female who was referred to surgical oncology OPD with a diagnosis of ovarian malignancy, based on raised cancer antigen 125 (CA 125) and suspected tubo-ovarian mass (TOM) on magnetic resonance imaging (MRI). A review of the MRI showed a pelvic collection with TOM, suggestive of infective pathology. Fungal culture and mass spectroscopy of the cystic collection identified the presence of Curvularia lunata. She was treated with oral itraconazole which showed symptomatic improvement and radiological response. In the follow-up period, the patient developed chest wall swelling, aspiration and geneXpert® revealed multidrug-resistant (MDR) tuberculosis, and treatment was started.ConclusionsUnusual causes of TOM and raised CA 125 should be kept in mind when dealing with young patients, as the possibility of epithelial ovarian cancer in this age is very low.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12957-022-02651-w.

Metaplastic carcinoma breast in male – A case report and review of literature

Male breast cancers are rare and account for 1% of all breast cancer cases reported annually. Incidence of metaplastic breast cancer in females is less than 1% thus metaplastic breast cancers in males are even rarer. Larger tumour size and higher grade differentiate them from invasive carcinoma. They are also more aggressive than invasive carcinoma. On IHC these are typically oestrogen- and progesterone-receptor, Her 2 neu negative. Here we report a rare case of a 35-year-old male patient who presented with left chest wall swelling for six months, histopathological examination showed it to be metaplastic carcinoma breast. The patient underwent left MRM and adjuvant chemotherapy.

A Rare Injury Due to Blunt Trauma: Rupture of Subclavian Artery Branch

Subclavian artery injury is an extremely rare and life-threatening condition. In this case, we discussed the diagnosis and treatment of the subclavian artery branch injury due to chronic blunt trauma caused by inappropriate traditional physical therapy. A 72-year-old male patient was admitted to the emergency department with sudden onset of pain and swelling in the left chest wall after inappropriate traditional physical therapy. He had a medical history of hemorrhagic stroke causing paralysis in his right arm and right leg. Muscle tension exercises were given to the patient by his relatives with the mechanism they built. Pulses were normal in the left upper extremity, and there was no difference in temperature and diameter between both upper extremities. The patient diagnosed with left subclavian artery branch rupture with computed tomography angiography was followed up with compression therapy without any surgical intervention and discharged with full recovery.

Subcutaneous bronchogenic cyst of the chest wall: A case report with brief literature review.

IntroductionBronchogenic cysts are congenital lesions found in the mediastinum, particularly the posterior-superior area. The current study aims to report a rare case of a subcutaneous bronchogenic cyst in the chest wall.Case reportA 41-year-old patient presented with a swelling of the chest wall. The mass had been present since birth. On examination, there was a large soft, round mass over the sternum subcutaneously. It was a fixed, non-flatulence, non-pulsatile, and non-tender mass.DiscussionUsually, the condition develops between the fifth and sixteenth weeks of gestation, when the primordial intestine separates into two parts: dorsal, which gives rise to the esophagus, and ventral, which gives rise to the pulmonary bud and tracheobronchial tree. As a result, the cyst is an ectopic lung bud that may or may not be connected to the tracheobronchial tree but lacks mesenchymal tissue.ConclusionAlthough chest wall bronchogenic cysts are uncommon, they should be considered in the differential diagnosis of cystic and soft tissue lesions in adults with chest wall swelling.

Tuberculous Abscess of the Chest Wall

Chest wall tuberculosis (TB) is a rare form of extrapulmonary TB, especially in an immunocompetent patient. The disease may resemble a pyogenic abscess or tumor. We present a young lady who developed a slowly growing chest wall swelling, proven as tuberculous etiology. J Bangladesh Coll Phys Surg 2022; 40: 136-137

Synthetic mesh placement - modality of choice in spontaneous intercostal pleural herniation: a case report

Hernia is defined as protrusion of a viscus or its part from the wall covering it and in some rare cases due to increased intercostal space there is spontaneous herniation of pleura and lung also known as extrathoracic lung hernia. A 48 year gentleman was admitted in our centre for chest wall swelling which has developed spontaneously 1 year back, painless, with cough impulse, further investigations like chest x-ray revealed nothing , subsequently CT thorax showed intercostal pleural hernia. He underwent surgery which diagnosed it as a case of intercostal pleural hernia having defect between 8th and 9th rib. Subsequently primary repair of defect was done with placement of monofilament mesh over it and then approximation of intercostal space was done with monofilament suture placed over 8th and 9th ribs. Post operatively patient had no complications and no recurrence of hernia. Spontaneous pleural herniation is a usually caused by coughing, heavy weight lifting, weakness of thoracic muscles by smoking, obesity etc. Ideal management is to treat the aetiology along with repair of the defect to prevent recurrence. In the present case the hernia developed after a bout of cough due to increased intercostal space between 8th and 9th ribs and also due to obesity leading to weak musculature. Intercostal pleural hernia repair can be achieved by primary repair of defect but it is advisable to use synthetic materials such as knitted monofilament polypropylene (Marlex) mesh to provide addition support to prevent recurrence.

Subcutaneous chest wall hamartoma: Case report

chest wall hamartoma is one of the rare findings in the practice of pediatrics surgery. The usual origin of chest wall hamartoma in literature are the ribs. Here we report a very rare case of hamartoma arising from the subcutaneous tissue of the chest wall. a 3 years old female child presented with painless chest wall swelling of 1 year duration. On examination, the mass was soft-firm, nontender and mobile measuring 5cm by 7 cm and located on the posterolateral chest. Chest x-ray showed soft tissue mass otherwise no rib abnormality. She was operated with a finding of solid mass with multi cystic component in the subcutaneous tissue with no extension to the ribs or the underlying muscles with clear margin of demarcation. Mass was completely excised and sent for pathology examination which showed hamartomatous lesion. Our patient has smooth post-operative course and discharged on her 5th post-operative day. Although chest wall hamartoma not arising from the rib is a very rare finding, it can mimic several benign and malignant lesions arising from the chest wall. Hence, preoperative imaging and proper pathologic evaluation are important to differentiate it from other masses.