Presentation
Cough with shortness of breath.
Patient Data
Large left thoracic solid-cystic mass of posteromedial location, most likely of pleural origin, measuring 15 x 11 x 10 cm with heterogeneous enhancement of the solid component. It encases partially the descending aorta with a mass effect on the adjacent structures (left pulmonary artery and main bronchus, lobar and segmental bronchi, pulmonary veins, left atrium and esophagus). A small heterogeneously enhancing pleural nodule is also noted at the left pulmonary apex.
The lung window shows passive lung base atelectasis with no metastatic nodule seen.
Numerous hepatic nodules with discontinuous peripheral enhancement (known as hemangiomas).
The remainder of the abdomen is unremarkable.
Case Discussion
CT features of a large left thoracic solid-cystic mass of posteromedial location, most likely of pleural origin.
The patient underwent a CT-guided biopsy with a histopathological exam that confirm the diagnosis of pleural synovial sarcoma.
The main differential diagnosis is pleural mesothelioma:
- strong association with exposure to asbestos fibers
- usually shows nodular thickening of soft tissue attenuation
- reduced volume of the affected hemithorax
- tends to cause "inward" contraction of the affected hemithorax with ipsilateral mediastinal shift
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