Unusual Thoracic Tumours- A Concise Imaging Approach

Abstract

Introduction: There are certain uncommon large thoracic masses sharing overlapping radiological features with commoner ones except few salient characteristic features. Diagnosing these uncommon tumours has practical implications for patient management and prognosis including obviating unnecessary surgeries. Aim: To demonstrate characteristic Computed Tomography (CT) features of large common and certain uncommon intra-thoracic masses Materials and Methods: A retrospective cross-sectional search was done in January 2020, from the archives of patients record in Radiology Department from December 2017 to January 2019 for intra-thoracic tumours. Those tumors or masses meeting inclusion criteria were analysed by two radiologists who were blinded about the histopathologic reports. A probable radiological diagnosis was made and it was later matched-up with the histopathologic reports to reach to a confirmed diagnosis. The unique CT features were separately tabulated and their p-value for a particular diagnosis was calculated using Fisher’s-exact test. Results: Out of total 23 cases studied, 12 bronchogenic carcinomas and 11 uncommon diagnoses including Solitary fibrous tumour, Synovial sarcoma, Pulmonary blastoma, Askin’s tumour, Schwannoma and Metastasis were found. Subtle rib erosion in Askin’s tumour (p-value=0.004), intra-tumoural vessels in Synovial sarcomas (p-value=0.0006) and intense enhancement in some non-bronchogenic tumours (p-value=0.0137) were found to be significantly associated features. Conclusion: When encountering an opaque hemithorax on chest radiograph and a large mass on CT, one should look for certain peculiar features of these unusual lung masses to suggest them as a differential diagnosis, as “Our eyes see only what our mind knows”.