In chest wall reconstruction after wide chest wall resection, the use of a musculocutaneous flap or prosthetic materials is inevitable for maintaining thoracic movement and a closed pleural cavity. We report a case of a 63-year-old male with a large invasive thymic carcinoma in the anterior mediastinum. The mass measured 6.8 cm and involved the sternum, left side of the parasternal area, ribs, and intercostal muscles. The patient underwent subtotal sternectomy, radical thymectomy, and reconstruction with biological mesh (Permacol). Successful chest wall reconstruction without any other complications was achieved, demonstrating the effectiveness of Permacol.
Collagen ; Humans ; Intercostal Muscles ; Male ; Mediastinum ; Pleural Cavity ; Ribs ; Sternum ; Thoracic Wall ; Thymectomy ; Thymoma

The appearance of a tumor in the chest wall is rare compared to that in any other part of the body. It can be classified into benign and malignant types and can be located in the rib, clavicle, sternum, cartilage and soft tissues. Tumors that are metastatic are commonly located in the lung, breast, bone and pleura. But, the soft tissue mass of anterior chest wall is rarely metastasized from a distant organ that is not confined to the thoracic cavity. This and thus has rarely been described. A 68-year-old man was admitted to our hospital with a chief complaint of resting dyspnea. A huge non-tender mass of about 10*15 cm in size was visible on his left lower anterior chest wall. We pathologically confirmed that the mass was a metastatic renal cell carcinoma of clear cell type by incision biopsy. Through an incision biopsy, the mass was pathologically confirmed as a metastatic renal cell carcinoma of the clear cell type.
Aged ; Biopsy ; Breast ; Carcinoma, Renal Cell* ; Cartilage ; Clavicle ; Dyspnea ; Humans ; Lung ; Neoplasm Metastasis* ; Pleura ; Ribs ; Sternum ; Thoracic Cavity ; Thoracic Wall* ; Thorax*

Desmoid tumors are rare soft tissue tumors arising from the fascia or from musculoaponeurotic structures. They are commonly seen in the extremities, but are rarely found in the thorax. Thoracic desmoid tumors commonly arise from the chest wall and rarely in the thoracic cavity. Imaging diagnosis of an intrathoracic desmoid tumor is difficult because there are no specific imaging findings for a desmoid tumor that can be differentiated from the various tumors of the chest wall, including a solitary fibrous tumor of the pleura. All desmoid tumor cells show negative immunohistochemical staining for CD34 in pathological specimen, a feature that makes it possible to differentiate a desmoid tumor from a solitary fibrous tumor of the pleura. Desmoid tumors are locally aggressive and the rate of local recurrence is very high. Consequently, wide radical resection is required and a preoperative accurate diagnosis of desmoid tumors is warranted. We describe the radiological findings of various imaging studies for an intrathoracic desmoid tumor. Our findings should facilitate a proper diagnosis of desmoid tumors.
Diagnosis ; Extremities ; Fascia ; Fibromatosis, Aggressive* ; Recurrence ; Solitary Fibrous Tumor, Pleural ; Thoracic Cavity ; Thoracic Wall ; Thorax

BACKGROUND: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. MATERIAL AND METHOD: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4+/-15.91 years (range: 17~76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. RESULT: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6+/-0.81 (range: 1~4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. CONCLUSION: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.
Cartilage ; Female ; Hematoma ; Humans ; Male ; Rib Fractures ; Ribs ; Sternum ; Thoracic Wall ; Thorax ; Transducers

Huge chondrosarcoma is a rare form of primary malignant tumor of the chest wall. We operated on a 60 year old female patient who had a huge anterior chest wall mass with local invasion into the pericardium and satellite tumors on the visceral pericardium of the heart. En-bloc resection of the huge tumor including both upper 3 ribs, both clavicles, manubrium of the sternum, pleura, and pericarium, was followed by complex chest wall reconstruction using a Gore-tex soft tissue patch and latissimus dorsi musculocutaneous free flap.
Chondrosarcoma* ; Clavicle ; Female ; Free Tissue Flaps ; Heart ; Humans ; Manubrium ; Mediastinal Neoplasms ; Middle Aged ; Pericardium ; Pleura ; Polytetrafluoroethylene ; Ribs ; Sternum ; Superficial Back Muscles ; Surgical Flaps ; Thoracic Wall* ; Thorax*

Synovial sarcoma is a rare malignancy in the thoracic cavity, especially in the mediastinum. In this paper, a case of primary mediastinal synovial sarcoma is reported. A 34-year-old woman was hospitalized with dyspnea. Her chest X-ray and computed tomography (CT) showed a 16x13x11 cm mass in her anterior mediastinal space. Surgical resection was performed but was incomplete. The pathological and immunohistochemical analysis confirmed the diagnosis of monophasic spindle cell synovial sarcoma. The patient underwent adjuvant radiotherapy for two months, but local recurrence and metastasis occurred in her pleural cavity. She eventually underwent chemotherapy for one year and died 18 months after her operation.
Dyspnea ; Female ; Humans ; Mediastinum ; Neoplasm Metastasis ; Pleural Cavity ; Radiotherapy, Adjuvant ; Recurrence ; Sarcoma ; Sarcoma, Synovial ; Thoracic Cavity ; Thorax

PURPOSE: The aim of this study was to compare the distribution and risk from hand positions applied at the center of the chest (CoC) versus the inter-nipple line (INL) during external chest compression by novice rescuers. METHODS: This simulation study included 105 participants. The participants were given photographs of the unexposed male chest and asked to mark a cross at the center of the chest and at the midpoint of the inter-nipple line. The range of contact with the chest was estimated by measuring the participants' palm width. The median and distribution of the two points were then compared and analyzed to determine whether the range in contact with the chest involved the xiphoid process. RESULTS: The level of the INL was approximately 0.8 cm higher at the sternum than the CoC (p<0.001), while the standard deviation of the CoC [1.8(0.6-3.8)] was higher than that of the INL [1.2(0.4-2.4)] (p<0.001). There were more cases in which the palm range involved the xiphoid process in the CoC group [15(14.3%)] than the INL group [1(0.9%)] (p<0.001). CONCLUSION: For male adult patients, chest compression at the level of the INL by novice rescuers is safer and more intensive than compression at the level of the CoC.
Adult ; Cardiopulmonary Resuscitation ; Hand ; Heart Massage ; Humans ; Male ; Nipples ; Sternum ; Thorax* ; Xiphoid Bone

A case in which broken pieces of glass are able to move freely in the pleural cav i t y without causing fatal or severe injury is very rare. I describe a case in which two pieces of glass which had penetrated the pleural cavity of a 14-year-old boy were surgically r e m ove d. Initial chest radiograph showed two crossed opacities in the right lateral chest wall around the minor fissure, while follow-up chest radiographs revealed mi-gration of a vertical piece of glass to the right lower lateral thorax and finally to the right lower medial thorax.
Adolescent ; Chest Pain* ; Child ; Follow-Up Studies ; Glass* ; Humans ; Male ; Pleural Cavity* ; Radiography, Thoracic ; Thoracic Wall ; Thorax*

Xiphodynia is a term used to describe a painful xiphoid process, and this is a rare musculoskeletal disorder that can radiate to the anterior chest, epigastrium, neck, shoulders and back. Clinical awareness of xiphodynia is important for making its correct diagnosis. We report here on two cases of xiphodynia. The diagnosis was suggested by the reproduction of the anterior chest pain or/and the epigastrium pain with light pressure on the xiphoid process. The patient of case 1 had suffered from xiphodynia throughout the years, and this patient underwent surgical excision of the xiphoid process. The patient of case 2 received an injection of local anesthetic agent to the xiphoid process.
Chest Pain ; Humans ; Light ; Neck ; Reproduction ; Shoulder ; Thoracic Wall ; Thorax ; Xiphoid Bone

Neurilemmomas are benign nerve sheath tumors derived from Schwann cells that rarely occur in the chest wall. Neurilemmomas of the chest wall are usually solitary lesions that bulge toward the pleural cavity. Neurilemmomas are confirmed histologically based on the presence of Verocay bodies, Antoni A and Antoni B tissue patterns and S-100 protein. Bilateral neurilemmomas in the chest wall are extremely rare, as are those that grow in the subcutaneous tissue but not the pleural area. We report here a case of bilateral chest wall neurilemmomas in which the tumors bulged out to the skin and were palpable.
Intercostal Nerves ; Nerve Sheath Neoplasms ; Neurilemmoma ; Pleural Cavity ; S100 Proteins ; Schwann Cells ; Skin ; Subcutaneous Tissue ; Thoracic Wall ; Thorax