Primary lung tumour invading the chest wall

This case study describes a primary lung tumour invading the chest wall, that clinically was thought likely to be a lipoma, and was imaged first using ultrasound.

A 67 year old male presented to his GP with a six month history of a lump increasing in size on the left upper chest wall. The ultrasound scan demonstrated a hypoechoic and hypervascular soft tissue mass, extending out of the chest into the subcutaneous tissue and starting to erode the overlying rib. The appearances were highly suspicious for a chest malignancy. Further imaging and an ultrasound guided biopsy confirmed the diagnosis of a squamous cell carcinoma.

The majority of patients who present to their general practitioner with a soft tissue mass commonly have benign abnormalities such as a lipoma or epidermoid cyst. Tumours of the chest wall are varied and are divided into benign and malignant tumours, and those that arise from the rib cage. Primary lung tumours are uncommonly seen on ultrasound. Lung cancers account for around 20% of all cancer deaths and the chest wall is involved in around 5% of primary lung tumours.

This case highlights the need for prompt investigation of enlarging superficial masses. Ultrasound imaging offers excellent detail for superficial structures and in this case, due to the location of the mass, identified a primary lung tumour.