CTICasesHigh-Grade Pleomorphic Chest Wall Sarcoma with Pulmonary Metastases
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Imaging findings
Chest radiograph demonstrates a subtle but extensive soft tissue density in the left supraclavicular and shoulder girdle region, resulting in elevation of the supraclavicular fat. Chest CT confirms a very large, necrotic soft tissue mass in the left chest wall associated with multiple small, bilateral pulmonary metastases, including nodules in the right middle lobe and left lower lobe. Biopsy of the mass reveals high-grade pleomorphic, poorly differentiated sarcoma.
Key takeaways
Chest wall sarcomas often present with vague symptoms such as intractable shoulder pain. Radiographs can easily be misread if the soft tissues of the shoulder girdle and supraclavicular regions are not carefully compared side-to-side. At the time of presentation, high-grade pleomorphic chest wall sarcomas are frequently large, necrotic, and already associated with hematogenous pulmonary metastases.
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