Learning objectives
To appreciate the wide spectrum of radiological appearances of thoracic sarcomas.
To be able to differentiate thoracic sarcomas from primary lung cancer.
To be able to offer a histological differential diagnosis based on certain imaging characteristics of thoracic sarcomas.
To understand the key role the radiologist plays in diagnosis,
evaluating disease extent and guiding management.
Background
Primary sarcomas of the thorax are an uncommon differential diagnosis for tumours involving the chest.
Primary thoracic sarcomas arise from soft tissues found in the mediastinum,
lung,
pleura and most commonly the chest wall.
The diagnosis can only be made after a process of exclusion of the more common malignancies such as primary lung cancer and metastasis.
The radiological differences are subtle and eventual diagnosis invariably lies in histological analysis. The principal role of radiology in the management of thoracic sarcomas is to evaluate the...
Imaging findings OR Procedure details
Thoracic soft tissue sarcomas are often slow growing lesions and patients frequently present with chest wall pain.
Plain radiographs commonly show a large solitary mass (Figure 1).
Although there is considerable overlap,
it may be possible to favour a diagnosis of thoracic sarcoma over primary lung cancer or lung metastases,
based on radiological appearances.
Primary thoracic sarcomas usually manifest as large,
heterogeneous,
poorly marginated and infiltrative masses (Figure 2) but can also appear as solitary pulmonary nodules or endobronchial tumours.
Metastases to the lungs is...
Conclusion
Thoracic sarcomas encompass a wide range of tumour subtypes and subsequently have a wide range of clinical presentations and imaging manifestations.
Occasionally they can mimic other malignancies and pose an even greater diagnostic challenge.
Key interpretation steps include ascertaining whether the tumour arises from the chest wall and what its composition is – features that could help to determine a histological subtype.
The radiologist plays an important role,
not only in diagnosis but to guide management.
References
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CT and MR imaging evaluation of chest wall disorders.
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Sabloff BM,
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Primary thoracic sarcomas.
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Imaging the anatomy of the brachial plexus: review and self-assessment module.
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Personal Information
Dr Demitrios Tzias is a Radiology Trainee,
St George's rotation,
London.
Dr Hilary Cassidy is a Radiology Trainee,
Chelsea and Westminster rotation,
London.
Dr Dariush Douraghi-Zadeh is a Radiology Trainee,
Chelsea and Westminster rotation,
London.
Dr Anand Devaraj is a Consultant Radiologist at St George's Hospital and the Royal Brompton Hospital.
Dr Arjun Nair is a Senior Academic Fellow at the Royal Brompton Hospital and Consultant Radiologist.