This case was presented in our Virtual IDEXX Diagnostic Imaging CE event, Summer of 2020.
History: Firm non-painful mass along left thoracic wall. Recently started coughing—dry and non-productive
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How did we grade this during the CE event?
|Large, sharply marginated, ovoid, mixed soft tissue and mineral opacity mass within left caudal thorax causing a mediastinal shift to the right and caudal displacement of the left crus of the diaphragm and widening of the left 6th intercostal space||2|
|Mixed lytic and productive lesion of left 7th rib with a large amount of amorphous periosteal reaction that extends both into the thoracic cavity and into the left thoracic wall soft tissues||2|
|Smooth periosteal new bone along left 6th rib||1|
|Thin linear and curvilinear metal opacity structures in stomach||0.5|
|Multifocal spondylosis deformans||0|
|Mass originating from left 7th rib: primary neoplasia of rib. Sarcoma (osteosarcoma, fibrosarcoma, chondrosarcoma, etc.) most likely.||3|
|Hepatomegaly: nonspecific—endocrine disease, nodular regeneration, neoplasia, or hepatitis.||0.5|
|Gastric foreign bodies||0.5|
Diagnosis: Primary osseous neoplasia of rib
A brief discussion on this case:
Though this mass has a very large intrathoracic component which may lead one to consider a pulmonary mass, such as a pulmonary carcinoma, as a differential for this case, the presence of aggressive left sided rib changes, particularly the degree of osteolysis of the left 7th rib, is consistent with a body wall mass (specifically for this patient a primary rib tumor – chondrosarcoma and osteosarcoma most commonly) with intrathoracic extension.