Chest wall + Diaphgram

Question 1

Chest wall lipoma/liposarcoma

Answer 1

Pathology:

• Mulitle lipoma is familial in 30% (Assoctioans: Cowden syndrome, Frohlich)
• Lipoma: mature adipocytes
• Liposarcoma: difficult to differentian between well-differentiatied liposar and lipo

CT:

• Lipoma: fat density lesions, +/- thin septations, may be poorly defined if intramuscular
• Liposarcoma: Fatty mass with thick sepations (>2mm), may be destructive, +/- necrosis/hemorrhage

Question 2

Chondrosarcoma

Answer 2

Pathology:

• Most common chest wall primary
• 10% of chondrosarcoma occur in chset wall
• Central; arise from medulllary cavity
• Peripheral: pre-existing chondroma/osteochondroma

CT:

• Well-circumscribed anterior chest wall mass
• Soft tissue component
• Calcifications: rings/arcs/popcorn
• Osseous destruction

MRI:

• T1: variable SI
• T2: High SI, low signal intensity foci coresponding to chondroid calcificaitons

Question 3

Eventration

Answer 3

• Lobular elevation or smooth hump-like morphology of anteromedial hemidiaphgram
• Preservation of posteior costophrenic angle on lateral
• Right > left
• Anteromedial part
• Sniff test: negative with delayed downward movement