Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was a 3 year old male with a palpable chest wall mass beneath the xiphoid for the last 6 months that was slowly increasing in size. The patient was also noted to be PPD positive.
Clinical Physical Exam:
Palpable, firm, non-mobile mass beneath the xiphoid.
Clinical Differential Diagnosis:
Ewing sarcoma, osteomyelitis, lipoma
An ultrasound exam from the day of presentation using high resolution linear transducers (not provided) failed to demonstrate a discrete soft tissue mass. An unenhanced chest CT exam from 2 months after presentation revealed a right sided chest wall mass that was of fat density, along with calcified right hilar and right paratracheal lymph nodes. A body CT exam performed several months later incidentally demonstrated a fatty mass in the left anterior thigh.
Images 1 and 2
Imaging Differential Diagnosis:
Anterior chest wall lipoma, past granulomatous disease
Four days after the chest CT exam this anterior chest wall mass was excised in the operating room. Clinically it appeared to be a lipoma, without distinct margins.
Examination of the pathological specimen revealed findings characteristic for a lipoma.
Lipoma, Chest Wall
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. The patient was later found to have a variant of Sotos syndrome called Ruvalcaba syndrome.
Case 15, Case 27, Case 46, Case 67, Case 68, Case 69
Follow us on Twitter @pedseducation and @pedsimaging
Please send us comments by filling out our Comment Form.
All contents copyright © 1992-2015 Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. and the authors. All rights reserved.
"Virtual Pediatric Hospital", the Virtual Pediatric Hospital logo, and "A digital library of pediatric information" are all Trademarks of Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D.
Virtual Pediatric Hospital is funded in whole by Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. Advertising is not accepted.
Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable or not.
The information contained in Virtual Pediatric Hospital is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.