Careful physical exam - does imaging need to be done for
PA and lateral chest films are the first step in looking for
origin of the mass and bone destruction. You need to determine if
the mass is from the chest wall (with visible bony destruction),
the pulmonary parenchyma, or the mediastinum (with bone erosion
and rib splaying)
Computed tomography or magnetic resonance imaging is the next
step, better characterizing the nature and extent of the lesion,
the organ of origin, and soft tissue and pleural and bony
involvement, thus narrowing the differential diagnosis. Computed
tomography excels in showing the bony and cartilaginous components
of the mass, and the presence of any pulmonary nodules. Magnetic
resonance provides complimentary information about the soft tissue
component of the mass, such as muscular, marrow, vascular, or
spinal canal invasion.
Tissue biopsy is required for definitive diagnosis, and
surgical resection for definitive cure.
CAP Case 39 - a 17 yo male with fever, flu, left lower lobe
infiltrate and left pleuritic chest pain. F/U films showed a
persistent left lower lobe abnormality. Presentation
CAP Case 27 - a newborn male with a large soft tissue mass in
the region of the right scapula. Presentation
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