Presentation
Left lateral chest wall lump, pulsatile and expansile on clinical exam.
Patient Data
CT chest with contrast
Contrast-enhanced exam. No previous cross-sectional imaging for comparison.
Heterogeneously but relatively avidly enhancing soft tissue mass lesion centered on the left lateral seventh rib, measuring 44 x 33 mm in greatest transaxial dimensions, with associated underlying rib destruction.
A few scattered foci of cystic change in the lungs, of doubtful significance. Bibasal atelectasis. Lungs are otherwise clear with no concerning pulmonary nodules.
I note prior history of total gastrectomy and previous bowel resection with stoma reversal (presumably around left splenic flexure given presence of hyperdense suture material).
Case Discussion
There is a limited differential for expansile vascular bony metastases, namely:
- renal cell carcinoma
- thyroid cancer
- hepatocellular carcinoma
- pheochromocytoma
- melanoma
- gastric carcinoma
For this specific case, the gastrectomy was performed due to adhesions secondary to previous colonic resection for colorectal cancer rather than gastric carcinoma.
The rib metastasis was subsequently biopsied, histopathology is in keeping with metastatic clear cell renal cell carcinoma, which is the most common type of renal cell carcinoma.
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