Intercostal nerve schwannoma

Case contributed by Dr Issac Yang

Presentation

Rule out pneumothorax

Patient Data

Age: 45 years
Gender: Female
X-ray

The radiograph was initially requested to rule out pneumothorax. There is no pneumothorax or other acute intrathoracic findings.

A rounded nodular opacity was incidentally found at the right thoracic apex, for which further assessment by CT was recommended.

CT

On CT, the well-defined right apical lesion is extrapleural, abutting the pleura and first rib, and seems to be associated with the T1 nerve root. Differential considerations include a peripheral nerve sheath tumor such as schwannoma versus a pleural based lesion such as solitary tumor of the pleura.

MRI

The right apical lesion can be seen arising eccentrically from the right first intercostal nerve on MRI. It is T1 iso- and heterogenously T2 hyperintense. There is avid post-contrast enhancement. The appearance is suggestive of a schwannoma of T1.

Case Discussion

Schwannomas are benign peripheral nerve sheath tumors. Our patient elected to have serial imaging follow-up for this mass, which remained unchanged in size and appearance on the two-year follow up scan.

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Case information

rID: 77799
Published: 21st May 2020
Last edited: 17th Feb 2021
Inclusion in quiz mode: Included
Institution: McGill University

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