Intercostal nerve neurilemmoma
Intercostal nerve neurilemmomas, also known as intercostal nerve schwannoma or neurinoma, are nerve sheaths encapsulated tumours affecting intercostal nerves.
Please refer to the article on schwannomas for a broad discussion about these tumours.
They account for less than 10% of primary neural tumours that arise in the chest (majority arise from the mediastinum 3). They occur commonly occur between 20 and 50 years of age 6.
Most patients tend to be asymptomatic as lesions are slow-growing 4. Some patient may have pain 7.
Please refer to the general article on schwannomas.
Lesions are usually solid well-circumscribed masses with homogeneous contrast enhancement. They are usually single but can rarely be multiple 4.
Solid nodules iso to slightly hyperdense showing homogeneous enhancement.
- T1: iso or slightly hyperintense compared to the adjacent muscles
- T2: hyperintense compared to the adjacent muscles
- T1 C+ (Gd): homogenous contrast enhancement
On imaging consider localised pleural masses including:
- 1. Petteruti F, De Luca G, Lerro A et-al. Intercostal ancient schwannoma mimicking an apical lung tumour. Thorax. 2008;63 (9): 845-6. doi:10.1136/thx.2007.082495 - Pubmed citation
- 2. Morimoto J, Nakajima T, Iizasa T et-al. Successful resection of schwannoma from an intercostal nerve causing bloody pleural effusion: report of a case. Surg. Today. 2011;41 (7): 989-91. doi:10.1007/s00595-010-4379-9 - Pubmed citation
- 3. McClenathan JH, Bloom RJ. Peripheral tumors of the intercostal nerves. Ann. Thorac. Surg. 2004;78 (2): 713-4. doi:10.1016/j.athoracsur.2003.09.022 - Pubmed citation
- 4. Chen F, Nakayama E, Okubo K et-al. Intrathoracic multiple schwannomas of a single intercostal nerve. Ann. Thorac. Surg. 2008;86 (2): 660-1. doi:10.1016/j.athoracsur.2008.02.004 - Pubmed citation
- 5. Ishida T, Inoue T, Inoue K et-al. Video thoracoscopic excision of an intercostal neurilemoma presenting as a lateral chest wall tumor. Surg Endosc. 1994;8 (5): 402-4. Pubmed citation
- 6. Tateishi U, Gladish GW, Kusumoto M et-al. Chest wall tumors: radiologic findings and pathologic correlation: part 1. Benign tumors. Radiographics. 2003;23 (6): 1477-90. doi:10.1148/rg.236015526 - Pubmed citation
- 7. Meyer C, Rodepeter F, Bartsch D, Kirschbaum A. Intercostal neurinoma: a rare cause of persistent thoracic pain. The Thoracic and cardiovascular surgeon reports. 3 (1): 48-50. doi:10.1055/s-0034-1376429 - Pubmed