Key Points

• Cross sectional imaging of computed tomography (CT) and magnetic resonance imaging (MRI) are the primary imaging modalities for evaluating chest wall abnormalities, including anomalies, trauma, infections and primary and secondary tumors. PETCT is helpful in staging of disease.
• Cross sectional imaging is useful for identifying the site and extent of involvement of chest wall abnormality and for followup of disease.
• The imaging characteristizes the lesion and suggest whether the etiology is more likely to be benign or malignant. In most cases biopsy is the definitive diagnostic test.

Although the major focus of thoracic imaging is on the lungs and mediastinum, imaging of the chest wall can also be abnormal. Evaluation of the chest wall, including the bones, muscles and fat should be a routine part of thoracic imaging and evaluation. Chest radiography is useful in evaluation of fractures in the setting of trauma, presence of boney anomalies, and for detecting calcifications in bone lesions. Although, plain films can reveal gross bone destruction and intrathoracic extension of chest wall masses, they are of limited value in the detection and characterization of more subtle bone lesions. Even relatively large soft tissue masses of the chest wall may not be detected or their extent fully appreciated on plain radiographs. Cross sectional imaging with CT and MRI offer the best evaluation of chest wall abnormalities[1],[2],[3],[4],[5],[6]. CT offers higher spatial resolution and depiction of cortical bone, calcification and vascular structuers. MR offers superior characterization of muscles and soft tissue. MRI and multidetector CT offer multiplanar imaging display which contributes to a thorough evaluation of the chest and a more accurate characterization of location and extent of disease.