Rib hemophiliac pseudotumor

Case contributed by Assoc Prof Craig Hacking

Presentation

Enlarging left chest wall mass. Hemophilia A.

Patient Data

Age: 50 years
Gender: Male
X-ray

Opacity projected over the left mid zone with destruction of the anterior 3rd rib and smooth scalloping of the anterior 4th rib. Associated rightward mediastinal shift. The cardiomediastinal contours are otherwise within normal limits. No consolidation, collapse, pleural effusion or pneumothorax is evident.

CT

Large mixed density ovoid soft tissue density mass within the left anterior chest wall measures 126 x 127 mm in the axial plane (increased compared to 116 x 112 mm previously) and 105 mm in the coronal plane. It is centered on the anterior left 3rd rib with rib splaying evident. Destructive bony changes in the associated left anterior 2nd, 3rd and 4th ribs. There is a further expansile lesion in the lateral aspect of the left 3rd rib which is unchanged in size and appearance. No new bony lesions identified.

The chest wall mass exerts mass effect on the left ventricle. The heart, pericardium and great vessels are otherwise within normal limits. No lymphadenopathy within the thorax by CT size criteria. The lungs and pleura are clear.

Limited views of the upper abdomen are within normal limits.

IMPRESSION

Slight increase in the size of the left anterior chest wall pseudotumor as described above but not exceeding that of the prior CT.

Case Discussion

Pseudotumors are an uncommon complication in hemophiliac patients, representing progressive swelling of muscle and/or bone due to repeated bleeding. The name pseudotumor is due to the fact these lesions often mimic tumors.

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Case information

rID: 78722
Published: 22nd Jun 2020
Last edited: 18th Aug 2020
Inclusion in quiz mode: Included

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