Chest wall infiltration

Introduction Chest wall infiltration: Chest wall tumors generally refer to tumors of deep soft tissue and skeletal tissue of the chest wall. Chest wall tumors can be divided into two major categories: primary and secondary. Secondary chest wall tumors are mostly caused by the metastasis of malignant tumors in other parts of the body to the chest wall tissue, or direct infiltration of lung or pleural malignant tumors adjacent to the chest wall. Primary chest wall tumors are rare, accounting for 5-10% of primary tumors, 80% of which occur in ribs, most of which are benign, about 20% occur in the sternum, and tumors in the sternum are more common. . Rib tumors occur in the anterior chest wall and the lateral chest wall, which is rare in the posterior chest wall.

Cause

Etiology and pathology: Primary chest wall tumors can be divided into: chest wall soft tissue tumor and chest wall bone tumor according to the site of occurrence. According to cell type, it can be divided into benign and malignant. Primary chest wall soft tissue tumors are more common, including fibroids, neurofibroma, schwannomas, lipomas and cavernous hemangioma. Malignant soft tissue tumors include fibrosarcoma, neurofibrosarcoma, liposarcoma, and malignant schwannomas.

Primary chest wall skeletal tumors are also more common, including chondroma, osteochondroma, giant cell tumor and bone cyst. Sometimes bone fiber structure is poorly developed or so-called osteoma-like lesions are also included in benign bone tumors. Malignant tumors include osteosarcoma, chondrosarcoma, myeloma, Ewing tumor and reticulocyte sarcoma.

an examination

Related inspection

Large biochemical examination electrocardiogram

X-ray examination: In addition to the use of positive lateral chest X-ray projection, it is necessary to take the tangential position of the tumor and multi-axis fluoroscopy. If necessary, artificial pneumothorax or pneumoperitoneum should be used to identify chest wall lesions, intrapulmonary lesions or diaphragmatic lesions. . Chest wall soft tissue tumor, X-ray shadow density is not high, the inner edge is clear, sharp, the outer edge is fuzzy, the tumor and the chest wall are obtuse angle, the base is close to the chest wall, and the pleural pleated line is visible at both ends of the tumor. When there is no adhesion between the tumor and the lung tissue, the fluoroscopy sees that the mass rises with the thorax as it inhales, and decreases when exhaled, opposite to the direction of motion of the lung texture. The benign bone tumors of the chest wall are generally round and elliptical, and the cortical bone is not broken. The malignant ones are mainly characterized by aggressive bone destruction. They are sieve-like and worm-like changes, and may have osteolytic or osteogenesis, and the edges are rough. Cortical bone defect, interruption or pathological fracture.

CT scan: The tumor location, shape, size, extent and presence or absence of metastasis can be clearly displayed. The CT value can be used to determine the tumor density, which is helpful for diagnosis. Ultrasound examination shows different images due to different tissue density of the tumor, which is helpful for diagnosis. Laboratory tests have diagnostic implications for certain tumors, such as urinary protein-positive patients with rib myeloma, and elevated serum alkaline phosphatase in malignant tumors with extensive bone destruction. If necessary, it is feasible to puncture or remove part of the tissue biopsy to confirm the diagnosis, but the biopsy is best carried out together with the surgical treatment.

Differential diagnosis

Imaging studies can identify chest wall tumors and lung tumors, and MRI can be used to distinguish soft tissue tumors from vascular lesions.

Most patients with early chest wall tumors have no obvious symptoms, and the severity of their symptoms is closely related to tumor size, growth rate and pathological type of tumor. Sometimes the patient finds a painless swelling or deformation of the chest wall. The mass of the mass is hard and the boundary is clear. Benign chest wall soft tissue masses are generally active, and chest wall bone tumors are fixed in the mass. Tumors in the anterior or lateral chest wall are generally easier to detect, and tumors in the posterior chest wall are often overlooked due to thicker soft tissue and scapula. Local chest wall pain and then chest wall mass is another symptom of chest wall tumors, such as rapid tumor growth, compression or infiltration of bone or intercostal nerve pain, persistent severe pain, suggesting that the tumor may be malignant. Tumors that occur in specific parts of the chest wall can produce brachial plexus or cervical and thoracic sympathetic chains that cause forearm pain and Horner syndrome. When a single chest wall isolating tumor is considered as a malignant tumor, the medical history should be detailed and systematically examined to determine the primary or metastatic nature of the tumor. In addition to lymphoid tumors, malignant tumors of the lungs, thyroid, breast, rectum, prostate, and kidney are more common in the chest wall. Chest X-ray is an important method for diagnosing chest wall tumors. It can not only determine that the tumor system is derived from the sternal bone, but also originates from the soft tissue, and can determine the tumor site of the chest wall bone, determine whether there is bone destruction, hyperplasia or deformation, and can also understand the relationship between the intrathoracic organ lesion and the chest wall tumor.

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