Incidental Solitary Fibrous Tumour of the Pleura on Trauma CT: A Radio-Pathological Correlation

Solitary fibrous tumours of the pleura (SFTPs) are rare growths that are usually benign, but their behaviour can be unpredictable. We describe the incidental discovery of an SFTP in a 39-year-old man who presented to the Emergency Department after a fall. Although he had no respiratory symptoms, trauma imaging unexpectedly revealed a pleural-based mass in the right upper chest. Further CT scans showed a 5.5 × 3 cm ovoid lesion with mixed enhancement along the right major fissure, and FDG-PET demonstrated low metabolic activity with no signs of spread. A CT-guided biopsy revealed spindle cells within a collagen-rich background and the typical "staghorn" vessels, with CD34 and STAT6 positivity confirming the diagnosis. The mass was removed via video-assisted thoracoscopic surgery, and histology confirmed a benign tumour without mitotic activity or necrosis. The patient recovered well and remained disease-free at follow-up. This case highlights how SFTPs can present unexpectedly in young, asymptomatic individuals and reinforces the importance of careful assessment of incidental thoracic findings. Although most SFTPs are curable with surgery, continued follow-up is recommended due to the occasional unpredictable behaviour of these tumours.