Presentation
Slowly increasing painless right posterior chest wall swelling for 6 months. No history of trauma or fever.
Patient Data
A well-defined fluid echogenicity lesion measuring about 11 x 3.5 x 7.5 cm is seen between the muscles and the underlying ribs in the right posterior chest wall. No calcifications, solid component or internal vascularity is seen in it.
A sizable well-defined lesion, hypo on T1 and hyperintense on T2-weighted images (fluid signal intensity), measuring about 12 x 11.5 x 3.5 cm, is seen along the right posterolateral chest wall beneath the right latissimus dorsi and serratus anterior muscles. A few fine septations are seen in it. No calcifications, fat/solid component, hemorrhage or diffusion restriction is seen in it. It shows vivid peripheral enhancement on the post-contrast images. The deep aspect of the lesion is in direct contact to the underlying ribs and intercostal muscles; however, no concerning MRI features of invasion are seen.
Well-defined localized right chest wall cystic lesion with prominent enhancing walls. Prime differential diagnosis includes scapulothoracic bursitis, chronic hematoma, or seroma.
Case Discussion
The patient underwent surgical excision of the lesion.
Gross description: Specimen submitted in a formalin container, labeled "right posterior chest wall mass" consists of a mass weighing 461 grams and measuring 16 x 10 x 5 cm. It has smooth external surface adherent to the adipose tissue. It had brownish chocolate color contents on opening. The internal surface shows small trabeculae.
Histopathology: scapulothoracic bursitis.
Case courtesy of Dr. Mamdouh Zidan.