Diagnostic Strategies for Chest Wall Masses
As new imaging modalities are introduced into the field of medicine, our ability to better diagnose chest wall masses has improved significantly. Although accurate diagnosis of a chest wall mass still requires thorough clinical evaluation along with imaging, continued advances in imaging beyond the standard chest radiograph allow us to manage and treat patients with higher acumen. Chest wall masses can present a diagnostic conundrum with a wide range of presenting symptoms and disease pathology, from inflammatory or infectious masses to benign or malignant neoplastic lesions. This chapter focuses on the differential diagnosis of chest wall masses and strategies to evaluate the etiology of these masses.
Chest wall tumors can arise from both the osseous structures or soft tissue of the thorax, and they may be primary, metastatic, familial or spontaneous. Because the underlying pathology of the mass can be one of several etiologies, presenting symptoms can range from asymptomatic (often an incidental finding when imaging is obtained for other purposes) to mild constitutional symptoms (such as fever, weight loss or night sweats) to painful, debilitating masses that are often malignant or metastatic tumors. Complete review of symptoms, along with elicitation of any history of trauma, infectious disease exposure, previous history of malignancy or radiation exposure is paramount in the workup. While malignant masses are more likely to present with pain, there are unfortunately no truly reliable clinical indicators to distinguish between benign or malignant processes.
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