CTICasesSchwannoma
Imaging findings
Chest radiograph shows a large, well-defined mass in the apex of the left hemithorax, with associated elevation of the left hemidiaphragm. CT and MRI confirm a giant, smooth-walled, heavily necrotic/cystic mass in the left apex causing local remodeling and lateral displacement of the first rib, and chronic denervation/atrophy of the left diaphragmatic crus. The mass is successfully resected, and histopathology confirms a benign schwannoma.
Key takeaways
Schwannomas are benign nerve sheath tumors arising from Schwann cells, frequently presenting in the posterior mediastinum or lung apex from intercostal or spinal nerve roots. They can grow to a giant size before detection, and undergo extensive cystic degeneration or necrosis that mimics a bronchogenic or duplication cyst on CT. Chronic compression of adjacent structures can lead to rib remodeling or nerve dysfunction (such as phrenic nerve palsy causing diaphragmatic eventration/atrophy).
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