Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
Search Ahead of print Current Issue Archives Instructions Subscribe e-Alerts Login 
Home Email this article link Print this article Bookmark this page Decrease font size Default font size Increase font size

Year : 2007  |  Volume : 2  |  Issue : 1  |  Page : 34-35
Unusual cause of a lung mass

Medical Imaging Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Correspondence Address:
Jamal Al Deen Alkoteesh
Cork University Hospital, Wilton CORK, Ireland

Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1817-1737.30362

Rights and Permissions

How to cite this article:
Alkoteesh JA, Shammas A. Unusual cause of a lung mass. Ann Thorac Med 2007;2:34-5

How to cite this URL:
Alkoteesh JA, Shammas A. Unusual cause of a lung mass. Ann Thorac Med [serial online] 2007 [cited 2023 Mar 23];2:34-5. Available from:

A 29-year-old female presented with complaints of cough, shortness of breath and sputum production for the last few years. There was a history of one episode of hemoptysis. She had no history of fever, weight loss or loss of appetite.

Clinical examination was unremarkable.

Chest radiographs [Figure - 1][Figure - 2] were obtained followed by a CT thorax [Figure - 3][Figure - 4].

   Questions Top

  1. What are the radiological findings on these images?
  2. What is the most likely diagnosis and the differential diagnosis of this appearance?

Radiology findings

On the CT scan, AP and lateral chest X-rays, about 9 cm in diameter oval-shaped solid mass with well-defined borders is seen, and it contains three flicks of calcification. The mass is situated in the left middle lung zone, extending medially into the left lung hilum. Posteriorly, the mass is found abutting the posterior chest wall without causing rib destruction; however, the adjacent rib has slightly increased density. The mass has homogenous density with minimal contrast enhancement. The rest of the lungs were clear, and no mediastinal lymphadenopathy was seen.

The differential diagnosis

Benign: Lung sequestration, bronchogenic cyst (CXR), hydatid cyst (CXR), chondroma, aspergiloma, neurofibroma, etc.

Malignant: Ewing's sarcoma, PNET, chondrosarcoma, neurofibrosarcoma, malignant fibrous histocytoma, lymphoma, etc.

Diagnosis: Thoracic Ewing's Sarcoma

   Discussion Top

Ewing's sarcoma is the most common primary skeletal tumor of the thoracic cage.[1] Fifteen percent of all Ewing's sarcomas arise primarily in the chest wall, usually from a rib or less frequently from the scapula. It has male predominance of 1.6:1 and typically occurs in children and young adults.

The radiology finding in the chest is a chest wall mass with rib destruction (82%), but mixed lytic-sclerotic (9%) and even sclerotic only (9%). However, Ewing's sarcoma occasionally manifests as a large intrathoracic mass with only a small component of bony involvement.

Extra-osseous intrathoracic Ewing's sarcoma is very rare, and it is usually seen in young adults and manifests as a well-circumscribed, noncalcified mass, more frequently in the paravertebral location. This tumor has propensity to spread inwards towards the lung hilum and into the spinal canal via the intervertebral foraramina.[2]

Involvement of bone marrow, the hallmark of an osseous origin, is typically absent at CT and MRI imaging in these extra-osseous tumors.

One-quarter to one-third of the patients with Ewing's sarcoma have metastases at the time of diagnosis, especially those with tumor close to the trunk. The most common sites of spread are lungs and bones; hence chest CT scan, MRI and bone scan are important in the patient work-up.[3]

Treatment is initially chemotherapy and usually followed by resection with or without radiotherapy. The overall 5-year survival rate is 50%.

   Conclusion Top

Ewing's sarcoma (extra-osseous or rib origin) should be considered in the differential diagnosis of any young patient who presents with a solid intrathoracic mass.

   References Top

1.Gladish GW, Sabloff BM, Munden RF, Truong MT, Erasmus JJ, Chasen MH. Primary thoracic sarcomas. Radiographics 2002;22:621-37.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Levine E, Levine C. Ewing Tumour of rib: Radiographic findings and computed tomography contribution. Skeletal Radiol 1983;9:227-33.  Back to cited text no. 2    
3.Ozaki T, Lindner N, Hoffmann C, Hillmann A, Rodl R, Blasius S, et al . Ewing's Sarcoma of the ribs: A report from the cooperative Ewing's Sarcoma study. Eur J cancer 1995;31A:2284-8.  Back to cited text no. 3    


  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]


Print this article  Email this article
   Next article
   Previous article 
   Table of Contents
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (71 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Figures

 Article Access Statistics
    PDF Downloaded574    
    Comments [Add]    

Recommend this journal