Chest wall tumors: radiologic findings and pathologic correlation: part 2. Malignant tumors

Malignant chest wall tumors are classified into eight main diagnostic categories: muscular, vascular, fibrous and fibrohistiocytic, peripheral nerve, osseous and cartilaginous, adipose, hematologic, and cutaneous. However, there are malignant tumors that arise in the chest wall and that do not fit well in any of these categories (eg, Ewing sarcoma and synovial sarcoma). Malignant chest wall tumors typically manifest as painful, rapidly growing, large palpable masses. Chest radiography, the technique most often used for initial evaluation, can be helpful for detecting cortical destruction. However, computed tomography is more sensitive than chest radiography for detecting calcified tumor matrix and cortical destruction. Magnetic resonance imaging often allows more accurate delineation and localization of the tumor and is helpful for determining the presence and extent of tumor invasion and for tissue characterization. Although the imaging features of many malignant chest wall tumors are nonspecific, knowledge of the typical radiologic manifestations of these tumors often enables their differentiation from benign chest wall tumors and occasionally allows a specific diagnosis to be suggested. The article reviews the clinical and imaging features of the most common malignant chest wall tumors and presents images collected at a single cancer referral center.