Thoracic wall lesions in children

Abstract

Our objective was to review the clinical features and radiographic manifestations of chest wall lesions in a pediatric chest unit. Twenty-five patients (11 males and 14 females, aged 14 months to 15 years) were suspected of having a chest wall lesion on the basis of clinical examination and chest radiograph. A retrospective review of clinical characteristics and radiographic findings was performed in order to define the pathology and extent of lesions and outcomes of chest wall diseases in children. Thirty-six percent of pediatric patients studied for thoracic abnormalities had anatomical variations of the thoracic cage such as sternal titling, bifid ribs, and costal cartilage convexities. Tuberculous infections of the sternum and ribs were seen in 4 cases. Osteochondromas were seen in 4 patients, and were especially noted in patients with a history of familial exostosis. Other malignant thoracic wall tumors included in this study included chondrosarcoma (n=1), Ewing's sarcoma (n=1), and primitive neuroectodermal tumor (n=2). In conclusion, the protruding lesions arising from the chest wall demonstrate a wide range of normal, congenital variant, and pathologic lesions arising from the soft tissues and bony components. Those with life-threatening lesions (less likely located in the parasternal region) are more prone to have chest pains and dyspneic respirations; in most cases, plain chest radiographs tend to have a high rate of bony or pleural involvement as well as thoracic deformities. In an endemic area of tuberculosis, costal tuberculosis should be considered in undiagnosed bony lesions; a chest CT scan could be diagnostically useful.

Chest Wall Abscess likely due to BCG Vaccination in a Child

“…Chest wall lesions are common in infancy and childhood and may encompass a wide spectrum of disease involving soft tissue as well as bony components [6]. Although chest wall abscess is a rare manifestation of childhood tuberculosis, tuberculosis should be also considered in the differential diagnosis of the chest wall tumor [7].…”

A complex congenital anomaly: liver eventration because of intrathoracic rib and vertebral segmentation disorder—a case report

“…Imaging plays an important role in the evaluation of congenital rib anomalies. The aforementioned radiographic investigations are indisputably indicated to diagnose congenital rib abnormalities such as an intrathoracic ribx-ray is the primary screening modality and CT is the pivotal feature [1,4,[6][7][8]. If differentiation of soft tissue is needed as in our case, the MRI should be the investigation of choice [7,8].…”

“…There is no need to treat most congenital rib anomalies because they are usually clinically insignificant [1,2,6,8]. An intrathoracic rib is frequently an incidental finding [2,4] as in our patient with astonishing normal lung function.…”

“…An intrathoracic rib is frequently an incidental finding [2,4] as in our patient with astonishing normal lung function. Observation for occurrence of respiratory distress or deterioration of lung function tests is appropriate [2,6]. Two years after discharge and without surgery, our patient is free of complaints.…”

Beware the bifid rib!

“…Studies by Donnelly et al 2 and Wong et al 3 demonstrated a prevalence of 33% and 36% respectively for anatomical variations of the chest wall. In another study, Donnelly et al demonstrated that all patients who presented with asymptomatic lesions of the chest wall had benign conditions, most commonly a congenital anomaly.…”