Department of Radiology, Gangnam Severance Hospital, Yonsei University, 146-92 Dogok-Dong, Gangnam-Gu, Seoul 135-720, Republic of Korea.
Radiographics. 2011 May-Jun;31(3):749-70. doi: 10.1148/rg.313105509.
Neoplasms and tumorlike lesions that originate from chest wall tissues are uncommon compared with tumors in other parts of the body, and unfamiliarity with these disease entities can cause diagnostic difficulties for radiologists. Furthermore, the imaging features of many of these tumors are nonspecific, particularly those that are locally aggressive. However, a systematic approach based on patient age, clinical history, lesion location, and characteristic imaging findings often helps limit the differential diagnosis. Primary chest wall tumors can be classified as bone or soft-tissue tumors, with the latter being further classified into adipocytic tumors, vascular tumors, peripheral nerve sheath tumors, cutaneous lesions, fibroblastic-myofibroblastic tumors, and so-called fibrohistiocytic tumors, largely based on the 2002 World Health Organization classification. Within each category, it is possible to further limit the differential diagnosis with cross-sectional imaging. Information on specific features (eg, mineralization, fibrosis, hemosiderin deposits) and imaging patterns (eg, the "target sign" and "fascicular sign" seen in neurogenic tumors) can aid in making the diagnosis. Radiologists can achieve a sufficiently specific diagnosis of bone tumors and soft-tissue tumors if typical findings are present.
与身体其他部位的肿瘤相比，起源于胸壁组织的肿瘤和肿瘤样病变较为少见，放射科医生对这些疾病实体不熟悉可能会导致诊断困难。此外，许多这些肿瘤的影像学特征是非特异性的，特别是那些局部侵袭性的肿瘤。然而，基于患者年龄、临床病史、病变位置和特征性影像学发现的系统方法通常有助于缩小鉴别诊断范围。原发性胸壁肿瘤可分为骨或软组织肿瘤，后者进一步分为脂肪性肿瘤、血管性肿瘤、周围神经鞘肿瘤、皮肤病变、成纤维细胞-肌纤维母细胞瘤和所谓的纤维组织细胞瘤，主要基于 2002 年世界卫生组织分类。在每个类别中，通过横断面成像可以进一步限制鉴别诊断。特定特征（例如矿化、纤维化、含铁血黄素沉积）和影像学模式（例如神经源性肿瘤中出现的“靶征”和“束状征”）的信息有助于做出诊断。如果存在典型表现，放射科医生可以对骨肿瘤和软组织肿瘤做出足够具体的诊断。
