Growing Chest Wall Research Articles

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.

UNVEILING FOLLICULAR THYROID CARCINOMA: A CASE OF EXTENSIVE CHEST WALL METASTASIS

Follicular thyroid carcinoma (FTC) typically presents with distant metastases, commonly involving the lungs and bones. However, extensive chest wall metastasis as the initial presentation of FTC is rare and poses diagnostic and therapeutic challenges. Here, we report a case of extensive chest wall metastasis revealing FTC in a 54-year-old female patient. The patient presented with a rapidly growing chest wall mass associated with pain and discomfort. Imaging studies revealed multiple lytic lesions involving the ribs and sternum. Fine-needle aspiration cytology (FNAC) of the chest wall mass confirmed the diagnosis of FTC. The patient underwent total thyroidectomy followed by adjuvant radioiodine therapy. Despite aggressive management, the disease progressed rapidly, highlighting the aggressive behavior of FTC with chest wall involvement. This case underscores the importance of considering FTC in the differential diagnosis of chest wall masses and the need for comprehensive staging and management strategies in such cases.

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

Surgical management of a rapidly growing chest wall mass of the neonate

Abstract A two-week-old infant male presented with an asymptomatic large left-sided chest wall mass. On physical exam, an approximately 3 cm firm, non-mobile mass was palpated in the upper left lateral chest wall. A chest radiograph and computed tomographic scan demonstrated a 5 cm mass of the chest wall with erosion and deformity of the left 5th and 6th ribs. An initial plan of non-operative management and close observation was employed, given the mass's benign appearance on imaging. However, after six weeks, the mass was noted to markedly increase in size, particularly the intrathoracic portion with compression of the underlying lung. An open surgical biopsy was performed with a frozen section, which suggested a mesenchymal hamartoma, and en bloc surgical resection was performed with GORE-TEX® patch reconstruction. After an uneventful postoperative course, the infant was discharged home and is doing well 12 months after surgery. The pre-operative and operative management considerations of chest wall masses of the neonate are discussed.

S2671 Chest Wall Metastasis as the First Clinical Manifestation of Hepatocellular Carcinoma: A Rare Case Report

INTRODUCTION: Hepatocellular carcinoma (HCC) is a highly malignant tumor that is mostly diagnosed at an advanced stage. Here, we report a metastatic HCC in an elderly man with hepatitis C virus (HCV) and alcoholic cirrhosis. Literature is sparse on chest wall metastasis. CASE DESCRIPTION/METHODS: A 69-year-old Caucasian man presented because of a growing left chest wall mass, back pain, and weight loss for three months. He had never visited a physician before; history was pertinent for tobacco smoking and alcohol dependence. He was hemodynamically stable, cachectic on examination with a >10 cm large left upper chest wall non-erythematous firm, fixed palpable mass. Labs were pertinent for elevated liver enzymes, with ALT of 141, AST of 374, ALP of 675, normal total bilirubin, and HCV antibody positive, with an elevated viral PCR of 6.1 log IU/ml. A CT chest, abdomen, and pelvis showed a left extrapleural chest wall mass measuring 10.8 × 15.5 × 11.0 cm with erosions of adjacent ribs, destructive lytic bony lesions, and liver cirrhosis; features suspicions of metastatic HCC. Subsequent chest wall mass biopsy confirmed a moderately differentiated metastatic HCC with Immunostain positive for CAM 5.2, Hep Par, glutamine synthetase, and glypican-3. A serum AFP was elevated at 2376.15 ng/ml. Abdominal MRI demonstrated a total of five large enhancing masses with the largest measuring 4.1 × 3.5 cm with arterial enhancement, washout, diffusion restriction, and internal hemorrhage consistent with biopsy-proven HCC (LR-5). A brain and spine MRI were unremarkable except for the previously reported bony metastases. Consequently, he received localized spine and left chest wall radiotherapy, and upon completion, he was discharged home, and currently, he is on systemic chemotherapy with Lenvatinib. DISCUSSION: HCC is the second most lethal neoplasm with an 18% five-year survival. Common etiologies are HBV, HCV, alcoholic cirrhosis, and NAFLD. The most frequent metastatic locations include bones, lymphatics, and adrenals. Spread occurs heterogeneously or via a lymphatic route or by direct invasion. Extrahepatic metastasis is rare and even rarer, with poorer prognosis when the first presentation is a mass at the metastatic site. This should be in the differential of rapidly growing chest wall masses, particularly in alcoholic and/or treatment-naïve hepatitis virus-infected patients. Timely recognition of risk factors can prevent and aid early diagnosis of such aggressive tumors.Figure 1.: Chest Wall Metastasis.Figure 2.: MRI Abdomen showing the Primary Liver Lesion.Figure 3.: Pathology Slide: H & E stain showing features suggestive of HCC on a liver biopsy.

Rapidly growing chest wall tumor of a pregnant woman: ewing’s sarcoma

Rapidly growing chest wall tumor of a pregnant woman: ewing’s sarcoma

Rapidly growing chest wall mass mimicking a malignant tumor: proliferative myositis

Rapidly growing chest wall mass mimicking a malignant tumor: proliferative myositis

Surgical Resection of Chest Wall Tuberculosis

Chest wall tuberculosis is a rare disease. After reviewing cases previously treated by surgical resection, the methods of resection, results, perioperative complications, and recurrence of the disease were analyzed. The clinical and radiological data of 21 patients with chest wall tuberculosis treated between March 1998 and May 2007 were reviewed retrospectively. Symptoms included growing chest wall mass, with the time intervals of surgical resection from symptoms ranging from one to eight months (mean 2.3 months). Fourteen patients had a past history of tuberculosis. Preoperative needle aspiration was performed in 10 patients. The lesion was confined to the chest wall without a pleural lesion in 4 patients; 14 patients had a chest wall lesion with a pleural space. Resection of the abscess without rib resection was performed in nine patients. Complete resection of the abscess together with soft tissue and the involved rib was performed in 12 patients. Recurrence occurred in two patients (9.5 %): one underwent complete resection with rib resection while the other had resection without rib resection. Chest wall tuberculosis requires surgical resection in most cases and complete surgical resection may be needed to keep the recurrence rate low.

Chest wall abscess due to Prevotella bivia

Prevotella bivia is associated with pelvic inflammatory disease. A 77-year-old man developed a rapidly growing chest wall abscess due to P. bivia within days. He underwent surgical resection of the infected area; his postoperative course was uneventful. This is the first case of chest wall abscess due to P. bivia infection. Its correct diagnosis cannot be underestimated because fulminant infections can occur in aged or immunocompromised patients if treated incorrectly. Prompt, appropriate surgical management, and antibiotic therapy affect treatment outcome.

Complete Resection is Mandatory for Tubercular Cold Abscess of the Chest Wall

Cold abscess of the chest wall is a rare disease and few literature reports detail any treatment experience with a limited patient number. Hence, an optimal treatment plan remains controversial. We retrospectively analyzed patients with cold abscess of the chest wall, focusing on their clinical features, surgical results, and the long-term outcome. Eighty patients were enrolled between May 1981 and April 2005. There were 35 male and 45 female patients, who underwent surgical treatment for cold abscess of the chest wall. The mean age of the patients was 31.4 +/- 12.5 (14 to 73) years. Forty patients (50.0%) had previous history of pulmonary tuberculosis. A growing chest wall mass was present in every patient. Surgical treatments performed were as follows: abscess debridement and drainage in 15 (18.8%), complete excision of the abscess without chest wall resection in 9 (11.2%), and complete excision of the abscess including chest wall in 56 patients (70.0%). There were no cases of operative mortality. Operative morbidity developed in four patients; two wound infections, one pneumonia, and one prolonged chest tube drainage. Postoperative antituberculous medication was given to all patients. Twelve patients (15.0%) recurred and required a second operation. The recurrence rate was higher in patients where only drainage of the abscess was performed compared with those in whom complete resection was performed (40.0% vs 9.2%, p = 0.008). Cold abscess of the chest wall can be surgically managed successfully with low operative risk. Complete resection of the abscess, including a portion of the involved chest wall, is mandatory to avoid recurrence.

Rupture of a chronic expanding hematoma of the thorax into lung parenchyma

Rupture of a chronic expanding hematoma of the thorax into lung parenchyma

Funnel chest. New aspects since introduction of a minimally invasive surgical technique

For many years, a variety of open surgery techniques represented the "golden standard" for remodeling the chest wall of patients with pectus excavatum. This situation changed when a minimally invasive approach was first introduced by D. Nuss (minimally invasive repair of pectus excavatum--MIRPE). This procedure was originally developed only for children and is based on the fact that the growing chest wall is still flexible. The indication for MIRPE is identical for both open surgery and the minimally invasive procedure. The new technique is gaining acceptance worldwide in the field of pediatric surgery, and older patients who resist open surgery for correction of their pectus excavatum now request the new and less invasive procedure. Most of them found their information via the Internet and it is noteworthy that patients, or their parents, are now looking differently at the indication for repairing pectus excavatum.