Chest Wall Swelling

65-year-old patient presented with lower left chest wall swelling since childhood.

Figure 1. Scanogram shows left lower chest wall mass.

Figure 2. Mass in left lower chest wall with few calcifications.

Figure 3. Multiple splenic cysts.

Figure 4. Mass showing enhancing tortuous vessels.

Figure 5. Mass showing enhancing tortuous vessels.

CT scan shows mass involving lower chest wall with areas of soft tissue density and fat.

Differential considerations for a mass involving the chest wall include hemangioma, infection, plasmacytoma or primary bone tumor, and soft-tissue masses such as lipoma, liposarcoma, neurogenic or desmoid tumor, and elastofibroma dorsi.

Cutaneous hemangiomas are identified at physical examination and rarely require imaging to establish a diagnosis.

The soft-tissue hemangioma in this patient was an intramuscular hemangioma of the left lateral chest wall.

Even less common are hemangiomas that occur in the chest wall.

Phleboliths are the only conventional radiographic finding helpful in diagnosing soft-tissue hemangioma, and these should be carefully searched for in every patient.

CT plays a role in the evaluation of the effect of deep soft-tissue hemangiomas on adjacent osseous structures.

Typically, T1-weighted MR images demonstrate a soft-tissue mass of intermediate signal intensity with interspersed areas of high signal intensity that can appear lacy and correspond to areas of fatty proliferation.

This patient underwent complete excision of the hemangioma in the left chest wall, and he remains healthy and without evidence of local recurrence three years later.