Chest Wall Tumor Aneesh 1

CASE PRESENTATION
DEPARTMENT OF CTVS
Moderator Presenter
Prof. Sanjay Kumar Dr. Aneesh Kumar
Professor & Head Junior Resident
Dept. of CTVS Dept. of General Surgery
24 years, Gentleman, driver in mining industry, resident of
Shaktinagar, Sonbhadra
Chief Complaints :
• Swelling over left side of chest for 15 years
• Pain over the swelling for 4 months
History of Presenting Illness
 A swelling over left side of upper chest wall for 15 years
• Insidious in onset
• Initially small in size (approx 1.5x1.5cm) and was
gradually progressed to current size (approx. 8 x 8cm)
• Not associated with any rapid increase in size or h/o
secondary changes over swelling (redness, ulceration,
fungation)
 Pain over swelling x 4 months
• Insidious in onset
• On and off
• Dull aching type
• Mild to moderate in intensity
• Non radiating
• Non referred
• No aggravating factors
• Relieved by oral medications
• No h/o fever, evening rise of temperature, night sweats
• No respiratory complaints
• No h/o any other swellings in the body
• No h/o trauma
• No h/o chest irradiation
Past History :
• Not a k/c/o HTN, T2DM, Tuberculosis, COPD ,
Asthma or any other chronic illness
• No h/o surgical intervention in past

Personal History :
• Takes mixed diet

• Normal sleep pattern
• Normal bladder and bowel habits
• Smoker from past 2 years (2 pack per year)
• No h/o Tabacco chewing
• Occasional Alcohol drinker (once in 3-4 months)
Family History
• No history swellings involving long bones or bones of hands &

feets or any abdominal lump in family
Allergic history
• Not allergic to any drugs and diet

GENERAL EXAMINATION
 Examined in a well lit room, informed consent
 Patient is conscious, Oriented, co-operative, sitting comfortably on bed
 Height – 169cm Weight - 67kg BMI- 23.45kg/m2

• Vitals
Afebrile
Pulse Rate =66/min, regular, normo - volumic, measured in right radial
artery.
Blood Pressure=136/76mmHg, right arm supine position
Respiratory Rate =16/min, Abdomino-thoracic
• No Pallor/Icterus/cyanosis/clubbing/Lymphadenopathy /Pedal oedema
• JVP : Not raised

Examination of Respiratory System
INSPECTION
• Bilaterally symmetrical
• Normal elliptical in shape
• No venous engorgement
• No intercoastal retraction
• Not using accessory muscles of
respiration
• No visible pulsation
• A swelling of size approx. 10 x
8 cm is seen over the anterior
aspect of left upper chest wall
on left side
 Ovoid in shape
 Surface appears smooth with
clearly defined edges
 Skin over swelling appears
to be normal
 No venous engorgement
 No visible pulsation
 No cough impulse
PALPATION
• Trachea central in position.
• Apical impulse in left 5th intercostal space just lateral to

midclavicular line, tapping in nature
• No subcutaneous emphysema
• No bony tenderness
• Vocal fremitus equal on both sides of lung field

• A swelling of size 11 x 9 cm is present
in the upper part of left anterior chest
wall, extending from lower border of
clavicle to upper border of 4 th rib
vertically and midline to 9.5 cm lateral
to midline on left side, with
 No local rise of temperature,

 Non-tender
 Surface is smooth,
 Well defined margins
 Hard in consistency
 Not mobile
 Not compressible/ reducible
 Non Pulsatile
 Skin over swelling is pinchable
 No Axillary or cervical lymph
nodes palpable
PERCUSSION
• Resonant note present over B/L lung field
• Dull note present over swelling
AUSCULTATION
• B/L normal vesicular breath sound heard
• No Bruit heard over swelling

Spine Examination : Normal
Other Systemic Examination:
• CVS: S1 , S2 heard , no added sound
• Abdominal : flat, soft, non tender, no evidence of lump.
• CNS: No neurological deficit

Summary:
• 24 years, gentleman presented with a swelling over chest wall on Left side since
15 years associated with pain over swelling for 4 months with no respiratory
complaints.
• On examination, An ovoid hard non-tender non-pulsatile, non-mobile, swelling
of size 11 x 9 cm is present in the upper part of left anterior chest wall, with
smooth surface & well defined margins and free from overlying skin but fixed to
chest wall and has dull note on percussion. Rest of the respiratory examination
revealed no abnormality.
PROVISIONAL DIAGNOSIS
SOFT TISSUE TUMOR (probably benign)

i.e. likely to be Osteochondroma
X-ray Chest PA view
CECT Thorax
A dumb bell shaped soft tissue mass lesion seen in the left para midline anterior chest wall with deep component extending
through 1st anterior intercostal space into anterosuperior mediastinal and the lesion reveals mild enhancement with multiple
calcific foci seen within lesion
• The superficial lesion is seen retro pectoral aspect and lesion measure
68 x 75 x 83 mm (SI x ML x AP)
• The mediastinal lesion seen in close proximity to mediastinal vessels and few
prominent vessels seen around mediastinal lesion
• Feature may S/O soft tissue neoplastic etiology (likely Benign)
FNAC
• USG Guided FNAC from chest wall mass

• Microscopic:- Smears are moderately cellular and shows spindle cells
in sheets. Individual cells have mildly pleomorphic nuclei,
inconspicuous nucleoli and indistinct cytoplasm, background shows
chronic inflammatory cells
• Impression:- F/S/O Spindle cell neoplastic lesion

Excision of the chest wall tumor on left side with dumb bell extension in left anterior mediastinum

Chest Wall Tumor Aneesh 1

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CASE PRESENTATION

• No h/o surgical intervention in past

• Takes mixed diet

• No history swellings involving long bones or bones of hands &

• Not allergic to any drugs and diet

 Patient is conscious, Oriented, co-operative, sitting comfortably on bed

 Height – 169cm Weight - 67kg BMI- 23.45kg/m2

• No Pallor/Icterus/cyanosis/clubbing/Lymphadenopathy /Pedal oedema

• JVP : Not raised

• Apical impulse in left 5th intercostal space just lateral to

• Vocal fremitus equal on both sides of lung field

 No local rise of temperature,

• Resonant note present over B/L lung field

• Dull note present over swelling

• B/L normal vesicular breath sound heard

• No Bruit heard over swelling

Other Systemic Examination:

• CVS: S1 , S2 heard , no added sound

• Abdominal : flat, soft, non tender, no evidence of lump.

• CNS: No neurological deficit

SOFT TISSUE TUMOR (probably benign)

• USG Guided FNAC from chest wall mass

• Impression:- F/S/O Spindle cell neoplastic lesion

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