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Eur J Cardiothorac Surg 2000;18:495-496
© 2000 Elsevier Science NL
Case report |
The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK
Received 24 February 2000; received in revised form 27 June 2000; accepted 18 July 2000.
Corresponding author. Tel.: +44-151-228-1616
e-mail: m.shackcloth{at}virgin.net
| Abstract |
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Key Words: Chest wall mass Scapular oesteochondroma Reactive bursa
| 1. Introduction |
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He gave a past history of having a right nephrectomy for a nephroblastoma as a neonate and a right orchidectomy for an undescended testicle.
On examination there was a 20x10 cm fluctuant tender mass on the right side of the chest wall. Chest X-ray showed some calcification in the soft tissues posterolaterally. CT scan showed an extensive fluid filled mass extending from under the anterior border of the scapular posteriorly, covering most of the posterior aspect of the scapula. There was also an exostosis arising from the anterior surface of the scapular (see Fig. 1) .
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Over the next month the mass increased in size rapidly and the pain became severe requiring hospital admission. The mass was therefore resected. At operation there was a 15x10 cm cystic mass arising from the outer surface of the 4th and 5th ribs. There was a bony exostosis arising from the anterior surface of the scapula. Both cyst and exostosis were excised.
Histology revealed the cyst to consist of a fibrotic connective tissue partly lined by vascular synovium. The exostosis was an osteochondroma (see Fig. 2) .
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| 2. Comment |
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There are four bursae connected with the scapulothoracic articulation [6]. There is an inconsistent bursa in the superficial layer between the inferior angle of the scapular and the superior fibres of latissimus dorsi. The next bursa lies between the superomedial scapular and the overlying trapezius. In the deep layer of tissues there are two bursae, one between serratus anterior and subscapularis, and one between the serratus anterior and the thoracic cage. It was the latter of these bursae which was enlarged in our patient.
There is a wide range of possible differential diagnosis of a chest wall mass. Pain in a chest wall mass arouses the suspicion of malignancy. CT scanning is of value in establishing the homogenous nature of the contents of the bursa as well as evaluating the exostosis itself for signs of malignant change [7]. The use of ultrasonography has been reported to be useful in the diagnosis of reactive bursa [8] and in retrospect may well have been helpful in this case.
In any chest wall mass it is important to establish the histological diagnosis to either confirm or exclude the presence of malignancy. Once the definitive diagnosis has been made appropriate treatment can be planned. In this case surgical excision of the osteochondroma allowed the scapula to move freely over the underlying ribs and intercostal muscles with subsequent resolution of the pain and bursitis. The latter had presumably been caused by friction between the osteochondroma and the underlying bursa.
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A. Fujikawa, Y. Oshika, T. Tamura, and Y. Naoi Chronic Scapulothoracic Bursitis Associated with Thoracoplasty Am. J. Roentgenol., November 1, 2004; 183(5): 1487 - 1488. [Full Text] [PDF] |
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