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E1066. Keep it Close to the Chest: A Review of Pediatric and Adult Chest Wall Tumors
Authors
  1. Jonathan Hammett; San Antonio Military Medical Center
  2. Doug Byerly; San Antonio Military Medical Center; Uniformed Services University of the Health Sciences
  3. Anthony Zarka; Baylor College of Medicine
  4. Michael Tall; UT Health San Antonio Department of Radiology
Background
Primary tumors of the chest wall are relatively uncommon with a variety of histological origins, including bone, cartilage, muscle, fat, nerves, and blood vessels. Although uncommon, more than 50% of chest wall tumors are malignant and appropriate diagnosis is important to ensure timely treatment and appropriate management. In some cases, the imaging appearance can be pathognomonic and a definitive diagnosis can be made on imaging alone. However, there is often significant overlap in radiographic features of benign and malignant entities, thus providing a definitive diagnosis is often not possible and tissue sampling may be indicated. The goal of this presentation is to review the imaging features of common benign and malignant primary chest wall tumors in a case-based format focusing on establishing an accurate, concise differential diagnosis and providing appropriate treatment recommendations while limiting unnecessary procedures.

Educational Goals / Teaching Points
Using case examples we will review the imaging features that correspond to both benign and malignant chest wall tumors focusing on imaging features more suggestive of benign etiologies to prevent unnecessary treatment or tissue sampling. Review imaging features concerning for malignant or aggressive processes which require tissue diagnosis or further treatment to include surgical excision. Discuss the use of clinical presentation, tumor location, history, and radiologic features to provide an appropriate differential when a specific diagnosis cannot be made.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Many imaging modalities play a role in the assessment of chest wall lesions. Radiographic imaging is often the first step in the assessment of these tumors and can provide insight into the underlying aggressiveness of the lesion when it is osseous in origin or invading the osseous structures. We will review the various aggressive and nonaggressive radiographic features of chest wall lesions. Ultrasound (US) generally has a limited role in the characterization of chest wall tumors; however, is often utilized for guiding tissue biopsy. Computed tomography (CT) is often complementary to radiographs providing information regarding tumor matrix, periostitis, and cortical destruction, however allows for more accurate assessment of tumor location, and the extent of local tissue involvement. Review magnetic resonance imaging (MRI) features which can be helpful for distinguishing benign from malignant entities when the imaging findings are nonspecific on other imaging modalities.

Conclusion
While chest wall lesions are uncommon a large proportion of the lesions are malignant requiring further treatment. In addition, there is significant overlap in the imaging appearance of benign and malignant chest wall lesions which can lead to misdiagnosis or unnecessary treatment. Therefore it is important for radiologists to be familiar with the varies etiologies presenting as chest wall masses, to be able to distinguish between them when possible, to formulate an appropriate differential diagnosis and recommend appropriate management such as further imaging or tissue sampling when indicated.