J Korean Soc Radiol.  2011 Jan;64(1):45-48. 10.3348/jksr.2011.64.1.45.

Angiosarcoma of the Chest Wall associated with Chronic Empyema and Pulmonary Metastasis: A Case Report

• Kim DW
• Lee KN
• Lee SY
• Roh MS

• KMID: 1443581
• DOI: http://doi.org/10.3348/jksr.2011.64.1.45

Abstract

Angiosarcoma of the chest wall is a very rare tumor and it is difficult to radiologically differentiate this tumor from other malignant tumors. Chronic tuberculous empyema is a predisposing factor that has been associated with angiosarcoma. We report here on a case of a 66-year-old man with angiosarcoma that arose in the chest wall. Computed tomography (CT) demonstrated a heterogeneous enhancing mass in the chest wall with calcified pleural thickening and multiple pulmonary nodules with the halo sign, which all indicated the presence of sarcoma with hypervascular metastases.

MeSH Terms

Aged
Chronic Disease
Empyema
Empyema, Tuberculous
Hemangiosarcoma
Humans
Multiple Pulmonary Nodules
Neoplasm Metastasis
Sarcoma
Thoracic Wall
Thorax

Figure

• 

  Fig. 1 A 66-year-old man with angiosarcoma of the chest wall and pulmonary metastases. A. The chest radiograph shows an extrapulmonary mass (arrow) in the left lower chest wall and multiple ill-defined pulmonary nodules (arrowheads) in both lungs. B, C. The axial CT images before (B) and after contrast injection (C) display a lobulated mass associated with calcified thickened pleura, proliferated extrapleural fatty tissue (arrow) and destroyed adjacent multiple ribs, and the mass is extending into the chest wall. D. The lung setting image at the level of the bronchus intermedius shows multiple pulmonary nodules each with a halo sign (arrow) in the right lung. E. The PET-CT images show multiple focal areas of increased uptake in the peripheral portion of the tumor (arrow). F. Immunohistochemically, the tumor cells are strongly positive for CD31 (×100).

Reference

1. Patel AM, Ryu JH. Angiosarcoma in the lung. Chest. 1993; 103:1531–1535.

2. Gladish GW, Sabloff BM, Munden RF, Truong MT, Erasmus JJ, Chasen MH. Primary thoracic sarcomas. Radiographics. 2002; 22:621–637.

3. Aozasa K, Naka N, Tomita Y, Ohsawa M, Kanno H, Uchida A, et al. Angiosarcoma developing from chronic pyothorax. Mod Pathol. 1994; 7:906–911.

4. Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M, et al. Malignancy associated with chronic empyema: radiologic assessment. Radiology. 1991; 178:417–423.

5. Tateishi U, Gladish GW, Kusumoto M, Hasegawa T, Yokoyama R, Tsuchiya R, et al. Chest wall tumors: radiologic findings and pathologic correlation: part 2. Malignant tumors. Radiographics. 2003; 23:1491–1508.

6. Ueda T, Andreas C, Itami J, Miyakawa K, Fujimoto H, Ito H, et al. Pyothorax-associated lymphoma: imaging findings. AJR Am J Roentgenol. 2010; 194:76–84.

7. Del Frate C, Mortele K, Zanardi R, Hunsaker AR, Nikpoor N, Cibas ES, et al. Pseudomesotheliomatous angiosarcoma of the chest wall and pleura. J Thorac Imaging. 2003; 18:200–203.

8. Sugita R, Takezawa M, Itinohasama R. Primary angiosarcoma of the chest wall: CT and MR findings. Radiat Med. 2002; 20:101–103.

9. Pinto PS. The CT Halo Sign. Radiology. 2004; 230:109–110.

10. Maeda T, Tateishi U, Hasegawa T, Ojima H, Arai Y, Sugimura K. Primary hepatic angiosarcoma on coregistered FDG PET and CT images. AJR Am J Roentgenol. 2007; 188:1615–1617.