Incidental discovery of a large thoracic mass in a 65-year-old dentist. Solitary localized fibrous tumor of the pleura.

摘要

A 65-year-old dentist consulted his general practitioner for his routine biannual medical checkup. The man had no symptoms, took no medication and had never smoked. The medical history of his family was unremarkable. The results of all routine laboratory tests, including tumor markers, were within normal ranges. On physical examination, the only abnormality was a decreased percussion sound over the left inferior hemitho-rax and hypophonesis of the left lower lung. Because of this abnormality, a chest radiograph was performed (fig. 1), which showed an extensive mass that occupied the lower third of the left hemithorax. The caudal parts of the mass abutted the entire left hemidiaphragm and had direct contact with the latero-basal parts of the chest wall. The cranial border of the mass was lobulated and well defined. Previous chest radiographs were not available, but a written report of an examination performed 4years before the current radiograph described a subtle opacity of the left costophrenic sinus that was interpreted as a small pleural scar. Computed tomography (fig. 2) revealed that the mass abuts the posterior and lateral costal curvature, the medial part of both the thoracic vertebrae and the descending aorta. The acute angles between the mass and the chest wall suggest a lung parenchymal origin. The mass was also adjacent to the left hemidiaphragm, but showed no signs of diaphragmatic invasion. Following intravenous contrast enhancement, the mass showed slightly inhomogeneous attenuation with hy-podense areas in the center of the lesion. Multiple intra-lesional corkscrew-like vessels and sparse popcorn-like calcifications could be also detected.