Chest Wall Lesions vs Intrathoracic Lesions

 

Incomplete border sign:

Border is produced by the interface of the chest wall opacity and air; once intrathoracic tissue becomes present the interface is lost and so is the border.

Chest Wall Lesions

Nipples, supernumerary nipples

Artifact

Skin lesions (moles, neurofibromas, extrathoracic musculature)

Mesenchymal tumors (muscle tumors, fibromas, lipomas, desmoid tumors

Neural Tumors (schwannoma, neurofibroma, neuroblastoma)

Hodgkin’s and non-Hodgkin’s lymphoma

Vascular tumors (hemangiomas and hemangiopericytomas)

Bone Tumors (mets, multiple myeloma, Ewing’s sarcoma, fibrous dysplasia, chondrosarcoma, osteosarcoma, fibrosarcoma, solitary plasmacytoma)

Hematoma

Rib fractures

Infections (actinomycosis, aspergillosis, nocardiosis, blastomycosis, tuberculosis, osteomyelitis

Thoracopulmonary small cell (Askin’s)

Invasion of a contiguous mass

 

Chest Wall Lesions with Rib Destruction

Mets (most common – lung, breast, renal cell)

Infection – Actinomycosis, aspergillosis, nocardiosis, tuberculosis, blastomycosis

Bone Tumors - multiple myeloma, Ewing’s sarcoma, fibrous dysplasia, chondrosarcoma, osteosarcoma, fibrosarcoma, solitary plasmacytoma

Note: benign lesions may erode the inferior surface but not destroy the rib i.e. Lipoma, Schwannoma, Neurofibroma

**Tumors that most commonly destroy ribs in adults are Mets and multiple myeloma.