Case 18

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was a 3 year old male with a palpable chest wall mass beneath the xiphoid for the last 6 months that was slowly increasing in size. The patient was also noted to be PPD positive.

Clinical Physical Exam:
Palpable, firm, non-mobile mass beneath the xiphoid.

Clinical Labs:
Positive PPD

Clinical Differential Diagnosis:
Ewing sarcoma, osteomyelitis, lipoma

Imaging Findings:
An ultrasound exam from the day of presentation using high resolution linear transducers (not provided) failed to demonstrate a discrete soft tissue mass. An unenhanced chest CT exam from 2 months after presentation revealed a right sided chest wall mass that was of fat density, along with calcified right hilar and right paratracheal lymph nodes. A body CT exam performed several months later incidentally demonstrated a fatty mass in the left anterior thigh.

Images 1 and 2

Image 3

Imaging Differential Diagnosis:
Anterior chest wall lipoma, past granulomatous disease

Operative Findings:
Four days after the chest CT exam this anterior chest wall mass was excised in the operating room. Clinically it appeared to be a lipoma, without distinct margins.

Pathological Findings:
Examination of the pathological specimen revealed findings characteristic for a lipoma.

Final Diagnosis:
Lipoma, Chest Wall

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. The patient was later found to have a variant of Sotos syndrome called Ruvalcaba syndrome.

Similar Cases:
Case 15, Case 27, Case 46, Case 67, Case 68, Case 69

References:
None

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