Dear Friends,
After the ECR, we all deserve an easy case. Showing routine control radiographs of a 51-year-old man operated on for synovial sarcoma of his right leg fourteen years ago.
Do you see any abnormality?
Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.
Click here for the answer to case #111
Findings: PA radiograph shows an opacity in the right apex with the typical appearance of an extrapulmonary lesion (A, arrow). It is seen better in the cone down view, which also shows a pneumothorax (B, arrows), secondary to percutaneous biopsy. The lateral view is unremarkable.
CT and MRI confirm a parietal mass (C,D, arrows). At surgery, a neurogenic tumour of the chest wall was found.
Final diagnosis: malignant schwannoma
Congratulations to j.d. who discovered the mass.
Teaching point: I am showing this case because it is an excellent example of extrapulmonary lesion: well defined and with tapering margins.
Apical pnumothorax…
yes, is apical pneumothorax
(and cervical rib)
pleural based mass rigH apical region associated with pneumothorax. In this clinical context, synovial sarcoma mets complicated by pneumothorax until proven otherwise. For CT thorax and biopsy of the pleural mass.
Metastases after fourteen years?
Apical pnumothorax and a mass in his arm.
…pneumotorace dx , da metastasi polmonare su pleurica….
…ma vi è’ anche pneumoperitoneo?
No pneumoperitoneum, or abdominal symptoms
Right apical neumothorax and extrapulmonary apical disease.
My sugestión is that metastasis from a sinovial sarcoma should be ruled out even after 14 years. I remember a case with a solitary 18cm lung metastases from a sinovial sarcoma with pulmonary vein invasión having being free of disease for over 20 years in a man that was 35.
Patient might have developed soft tissue sarcoma of the right arm from radiation given to treat the very primary tumor. Average time between radiation and diagnosis could be about 10 years I think.