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Simple Summary: In this study, we present the case of a dog diagnosed with a large thoracic wall extraskeletal osteosarcoma, which was successfully treated through chest wall reconstruction using a titanium mesh. This approach involved the en bloc resection of multiple ribs and the secure placement of a titanium mesh to reconstruct the chest wall. The dog showed significant improvement post-surgery, with no signs of disease recurrence or metastasis at the 8-month follow-up. This case highlights the effectiveness of titanium mesh in providing structural support and promoting recovery in dogs undergoing extensive chest wall resections due to large tumors. A 6-year-old castrated male mixed dog presented with a rapidly growing mass at the right chest wall two weeks after initial detection. A mesenchymal origin of the malignancy was suspected based on fine-needle aspiration. Computed tomography (CT) revealed that the mass originated from the right chest wall and protruded externally (6.74 × 5.51 × 4.13 cm3) and internally (1.82 × 1.69 × 1.50 cm3). The patient revisited the hospital because of breathing difficulties. Radiography confirmed pleural effusion, and ultrasonography-guided thoracocentesis was performed. The effusion was hemorrhagic, and microscopic evaluation showed no malignant cells. Before surgery, CT without anesthesia was performed to evaluate the status of the patient. The 7–10th ribs were en bloc resected at a 3-cm margin dorsally and ventrally, and two ribs cranially and caudally from the mass. After recovering the collapsed right middle lobe of the lung due to compression from the internal mass with positive-pressure ventilation, a 3D-printed bone model contoured titanium mesh was tied to each covering rib and surrounding muscles using 2-0 blue nylon and closed routinely. The thoracic cavity was successfully reconstructed, and no flail chest was observed. The patient was histo-pathologically diagnosed with extraskeletal osteosarcoma. A CT scan performed 8 months after surgery showed no evident recurrence, metastasis, or implant failure. This is the first case report of chest wall reconstruction using titanium mesh in a dog. The use of a titanium mesh allows for the reconstruction of extensive chest wall defects, regardless of location, without major postoperative complications. [ABSTRACT FROM AUTHOR]

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor of intermediate malignancy and uncertain differentiation. To date, only four patients diagnosed with AFH located in the chest wall have been described. Herein, we describe a 44-year-old woman diagnosed with breast infiltrating lobular carcinoma. During the imaging study with positron emission tomography-computerized tomography scan, a 4 cm solid lesion located in the chest wall was identified. Fine-needle aspiration followed by surgical excision with intraoperative frozen section study was performed. The combined histomorphologic, immunohistochemical, and molecular findings confirmed the diagnosis of AFH. In this report, we describe, to the best of our knowledge, the first patient with synchronous AFH and breast cancer. [ABSTRACT FROM AUTHOR]

Intercostal lung hernia and inverted intercostal hernia are rare chest wall hernias usually asymptomatic and detected incidentally on chest radiograph. In this case report, we discussed here on the chest radiograph and computed tomography imaging findings of two cases of these rare hernias with an emphasis being in differential diagnosis of chest tumors.

Abstract Background Malignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy. Methods Forty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated. Results Total local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p

Ectopic breast tissue, which results from incomplete regression of the mammary line during embryogenesis, is observed in 0.2%–6% of the population. Carcinoma development in ectopic breast tissue, especially in the abdominal or chest wall, is rare. Here we present the unusual case of a 38-year-old woman with invasive ductal carcinoma in the ectopic breast tissue on the left side of the chest wall and concurrent fibroadenoma in the ectopic breast tissue on the right side. We also describe the US and MR findings of these masses.

Soft tissue myxomas are benign mesenchymal neoplasms typically found in the intramuscular components of the proximal extremities. However, soft tissue myxomas in the chest wall are rare. We report the case of a 41-year-old woman with soft tissue myxoma who presented with a slowly growing, palpable lump on her left anterior chest wall that has been present for several years. Mammography revealed an oval, circumscribed, and hyperdense mass in the retromammary fat layer of the upper inner quadrant of the left breast. Ultrasonography revealed an oval, circumscribed, and hypoechoic mass with internal echoes and multiple microcystic spaces. A triangular hyperechoic area adjacent to the pole of the mass and peripheral hyperechoic rim were also detected. The patient underwent surgical excision and was diagnosed with soft tissue myxoma with subcutaneous manifestation.

Aim: Malignant chest wall tumors are rare in children. We aimed to study the management of the Ewing family of tumors (EFT) in the chest walls of children. Materials and Methods: The files of patients diagnosed with primitive neuro-ectodermal tumor and Ewing sarcoma of the chest wall in the prior 2 decades were retrospectively reviewed. Results: A total of 15 children with a median age of 10 (8-14) years were included. Their symptoms were palpable mass (n=6), chest pain (n=4), B symptoms (n=2), cough (n=2) and abdominal pain. Their history revealed delayed diagnoses in 1/3 of the patients due to a misinterpretation of the symptoms. All children except for one had tru-cut biopsy and upfront chemotherapy. The median greatest diameter of mass at diagnosis was 100 (67-148) mm and 51 (39-100) mm at preoperative imaging after chemotherapy. Pleural effusion (n=8), costal destruction (n=9), extension to neural foramina (n=3), pulmonary or diaphragmatic nodule (n=5) and distant bone metastasis (n=4) were present at diagnosis in some cases. More than one surgery was performed in 9 (60%) of the children in order to remove the primary tumor and metastases. Costal excision (n=11), diaphragmatic resection (n=6) and chest wall reconstruction with graft material were performed on 8 patients. All cases had radiotherapy postoperatively. Mortality occurred in 9 (60%) patients due to local recurrences or metastases. Only 3 children reached 5-year survival and were considered to be cured. The remaining 3 patients completed their first line oncologic treatments and were under surveillance without treatment. Conclusion: The EFT in the chest wall are aggressive tumors with poor prognosis despite multimodality treatment. Surgeons dealing with these patients should be familiar with complex chest wall reconstruction techniques.

Abstract Introduction Surface‐guided radiation therapy (SGRT) has emerged as a powerful tool to improve patient setup accuracy in radiation therapy (RT). Combined with the goal of increasing RT accuracy is an ongoing effort to decrease RT side effects. The application of a prophylactic skin dressing to the treatment site is a well‐documented method of reducing skin‐related side effects from RT. This paper aims to investigate whether the application of Mepitel, a prophylactic skin dressing, has an impact on the accuracy of surface‐guided patient setups in chest wall RT. Methods A retrospective analysis of daily image‐guided Online Corrections (OLCs) from patients undergoing chest wall irradiation with SGRT was performed. Translational (superior–inferior, lateral, and anterior–posterior) OLC magnitude and direction were compared between patients treated with Mepitel applied and those treated without. Systematic and random errors were calculated and compared between groups. Results OLCs from 275 fractions were analysed. Mean OLCs were larger for patients with Mepitel applied in the superior_inferior axis (0.34 vs. 0.22 cm, P = 0.049) and for the combined translational vector (0.54 vs. 0.43 cm, P = 0.043). Combined translational systematic error was slightly larger for patients with Mepitel applied (0.15 vs. 0.09 cm). Conclusion Mepitel can impact the accuracy of SGRT patient‐positioning in chest wall RT. The variation however is small and unlikely to have any clinical impact if SGRT is coupled with image guidance and appropriate PTV margins. Further investigation is required to assess the effect of Mepitel on SGRT accuracy in other treatment sites, as well as any potential dosimetric impacts.

Background: Malignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy. Methods: Forty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated. Results: Total local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05–111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693–0.957; p = 0.0126). Conclusions: Surgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer. [ABSTRACT FROM AUTHOR]

Background: Pectus excavatum (PE) is a common congenital chest wall deformity with various associated health concerns, including psychosocial impacts, academic challenges, and potential cardiopulmonary effects. Objective: This study aimed to investigate the cardiac consequences of right atrioventricular groove compression in PE using cardiac magnetic resonance imaging. Materials and methods: A retrospective analysis was conducted on 661 patients with PE referred for evaluation. Patients were categorized into three groups based on the degree of right atrioventricular groove compression (no compression (NC), partial compression (PC), and complete compression(CC)). Chest wall indices were measured: pectus index (PI), depression index (DI), correction index (CI), and sternal torsion. Results: The study revealed significant differences in chest wall indices between the groups: PE, NC=4.15 ± 0.94, PC=4.93 ± 1.24, and CC=7.2 ± 4.01 (P<0.0001). Left ventricle ejection fraction (LVEF) showed no significant differences: LVEF, NC=58.72% ± 3.94, PC=58.49% ± 4.02, and CC=57.95% ± 3.92 (P=0.0984). Right ventricular ejection fraction (RVEF) demonstrated significant differences: RVEF, NC=55.2% ± 5.3, PC=53.8% ± 4.4, and CC=53.1% ± 4.8 (P≥0.0001). Notably, the tricuspid valve (TV) measurement on the four-chamber view decreased in patients with greater compression: NC=29.52 ± 4.6; PC=28.26 ± 4.8; and CC=24.74 ± 5.73 (P<0.0001). Conclusion: This study provides valuable insights into the cardiac consequences of right atrioventricular groove compression in PE and lends further evidence of mild cardiac changes due to PE. [ABSTRACT FROM AUTHOR]

Background Pectus excavatum deformities are usually repaired with a minimally invasive approach in which a metal bar is used to correct the chest wall abnormality. We aimed to evaluate long-term outcomes and patient satisfaction after surgical correction. Methods Patients who underwent pectus excavatum repair and subsequent bar removal at a single tertiary care center from January 2000 to December 2020 were identified. A retrospective chart review was performed, and a telephone survey was conducted to evaluate perceived inward chest movement, need for surgeon reevaluation, surgical reintervention, and overall satisfaction. Data are presented as medians with interquartile ranges (IQRs) and frequencies with percentages. Results A total of 583 patients were included. The survey response rate was 26.2% (n = 153). The respondents were predominantly male (80.4%, n = 123) with a median age at surgical correction of 14.9 years (IQR 12.9, 16.1) and a median Haller index (HI) of 3.8 (IQR 3.4, 4.5). Median time to bar removal was 2.9 years (IQR 2.5, 3.0) with a median age at removal of 17.7 years (IQR 15.5, 19.0). Median time from surgery to survey follow-up was 9.6 years (IRQ 5.0, 11.4) with respondents having a median age at follow-up of 25 years (IQR 22.0, 28.4). The satisfaction rate was 96.7% (n = 148) with a reintervention rate of 2.0% (n = 3). The perceived inward chest movement was 30.7% (n = 47) with 12.8% (n = 6) of those requesting surgical reevaluation. Conclusion There is a high level of satisfaction many years after correction of pectus excavatum and bar removal. With the advent of cryoablative therapy since 2017, patient satisfaction improved by experience of less postoperative pain. Reintervention rate is low despite some patients reporting a perceived chest wall inward movement. [ABSTRACT FROM AUTHOR]

Ectopic breast tissue, which results from incomplete regression of the mammary line during embryogenesis, is observed in 0.2%-6% of the population. Carcinoma development in ectopic breast tissue, especially in the abdominal or chest wall, is rare. Here we present the unusual case of a 38-year-old woman with invasive ductal carcinoma in the ectopic breast tissue on the left side of the chest wall and concurrent fibroadenoma in the ectopic breast tissue on the right side. We also describe the US and MR findings of these masses. [ABSTRACT FROM AUTHOR]

Aim: Malignant chest wall tumors are rare in children. We aimed to study the management of the Ewing family of tumors (EFT) in the chest walls of children. Materials and Methods: The files of patients diagnosed with primitive neuro-ectodermal tumor and Ewing sarcoma of the chest wall in the prior 2 decades were retrospectively reviewed. Results: A total of 15 children with a median age of 10 (8-14) years were included. Their symptoms were palpable mass (n=6), chest pain (n=4), B symptoms (n=2), cough (n=2) and abdominal pain. Their history revealed delayed diagnoses in 1/3 of the patients due to a misinterpretation of the symptoms. All children except for one had tru-cut biopsy and upfront chemotherapy. The median greatest diameter of mass at diagnosis was 100 (67-148) mm and 51 (39-100) mm at preoperative imaging after chemotherapy. Pleural effusion (n=8), costal destruction (n=9), extension to neural foramina (n=3), pulmonary or diaphragmatic nodule (n=5) and distant bone metastasis (n=4) were present at diagnosis in some cases. More than one surgery was performed in 9 (60%) of the children in order to remove the primary tumor and metastases. Costal excision (n=11), diaphragmatic resection (n=6) and chest wall reconstruction with graft material were performed on 8 patients. All cases had radiotherapy postoperatively. Mortality occurred in 9 (60%) patients due to local recurrences or metastases. Only 3 children reached 5-year survival and were considered to be cured. The remaining 3 patients completed their first line oncologic treatments and were under surveillance without treatment. Conclusion: The EFT in the chest wall are aggressive tumors with poor prognosis despite multimodality treatment. Surgeons dealing with these patients should be familiar with complex chest wall reconstruction techniques. [ABSTRACT FROM AUTHOR]

Introduction: Surface‐guided radiation therapy (SGRT) has emerged as a powerful tool to improve patient setup accuracy in radiation therapy (RT). Combined with the goal of increasing RT accuracy is an ongoing effort to decrease RT side effects. The application of a prophylactic skin dressing to the treatment site is a well‐documented method of reducing skin‐related side effects from RT. This paper aims to investigate whether the application of Mepitel, a prophylactic skin dressing, has an impact on the accuracy of surface‐guided patient setups in chest wall RT. Methods: A retrospective analysis of daily image‐guided Online Corrections (OLCs) from patients undergoing chest wall irradiation with SGRT was performed. Translational (superior–inferior, lateral, and anterior–posterior) OLC magnitude and direction were compared between patients treated with Mepitel applied and those treated without. Systematic and random errors were calculated and compared between groups. Results: OLCs from 275 fractions were analysed. Mean OLCs were larger for patients with Mepitel applied in the superior_inferior axis (0.34 vs. 0.22 cm, P = 0.049) and for the combined translational vector (0.54 vs. 0.43 cm, P = 0.043). Combined translational systematic error was slightly larger for patients with Mepitel applied (0.15 vs. 0.09 cm). Conclusion: Mepitel can impact the accuracy of SGRT patient‐positioning in chest wall RT. The variation however is small and unlikely to have any clinical impact if SGRT is coupled with image guidance and appropriate PTV margins. Further investigation is required to assess the effect of Mepitel on SGRT accuracy in other treatment sites, as well as any potential dosimetric impacts. [ABSTRACT FROM AUTHOR]

Chest-wall sarcomas are treated with extensive resections and complex defect reconstruction to restore chest-wall integrity. It is a difficult surgical procedure that incorporates a multidisciplinary approach for the best outcome, preventing paradoxical chest movement issues and reducing complications. We aimed to describe our experience of chest-wall reconstruction using polypropylene mesh (Marlex® Mesh) combined with methyl-methacrylate and soft-tissue coverage with a latissimus dorsi flap following sarcoma resection. Among the 53 patients treated for primary chest-wall sarcomas at the European Institute of Oncology (IEO) in Milan, Italy, from 1998 to 2020, 14 cases underwent chest-wall resection and reconstruction using polypropylene mesh, methyl-methacrylate and the latissimus dorsi flap. Patients with locally advanced breast cancers, locally advanced lung cancers, squamous cell carcinomas, and other secondary chest-wall malignancies were excluded from the study, as were the patients with different types of chest-wall reconstruction. In this study, 14 patients (6 men and 8 women) with various primary chest-wall sarcomas were enrolled. On an average, 2 ribs (range: 1–5) were removed during the surgeries, and the chest-wall defects ranged from 20 to 150 cm2 with an average size of 73 cm2. The mean follow-up period for these patients was approximately 63.80 months The combination of Marlex® mesh filled with methyl-methacrylate and covered using latissimus dorsi myocutaneous flap provides safe, low-cost and effective single-stage chest-wall reconstruction after surgery for primary sarcomas. [ABSTRACT FROM AUTHOR]

Chest wall reconstruction is among one of the most challenging surgeries because the defect comprises multiple components and each needs to be reconstructed separately with like tissues. Chest wall reconstruction ranges from simple skin cover to complex bony and or mediastinal/precordial reconstruction. Various methods of reconstruction include autologous as well alloplastic techniques. Autologous techniques include regional or distant flaps with or without bone. Whereas alloplastic techniques include the placement of a variety of implant materials like titanium plate/mesh, stainless steel mesh, medpore and biocompatible 3D-printed models. we present this article where extensive resection was performed, aiming to complete removal of recurrent chest wall chondrosarcoma and defect included all components of chest wall including precordial lining. The reconstruction was performed by using combined autologous as well as alloplastic techniques using acrylic implant. [ABSTRACT FROM AUTHOR]

Background: Major thoracic trauma represents a life-threatening condition, requiring a prompt multidisciplinary approach and appropriate pathways for effective recovery. While acute morbidity and mortality are well-known outcomes in thoracic-traumatized patients, long-term quality of life in patients surviving surgical treatment has not been widely investigated before. Methods: Between November 2016 and November 2023, thirty-two consecutive patients were operated on because of thoracic trauma. Age, sex, comorbidities, location and extent of thoracic trauma, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Organ Injury Scale (OIS), intra and extrathoracic organ involvement, mechanism of injury, type of surgical procedure, postoperative complications, ICU and total length of stay, immediate clinical outcomes and long-term quality of life—by using the EQ-5D-3L scale and Numeric Rate Pain Score (NPRS)—were collected for each patient Results: Results indicated no significant difference in EQOL.5D3L among patients with thoracic trauma based on AIS (p = 0.55), but a significant difference was observed in relation to ISS (p = 0.000011). Conclusions: ISS is correlated with the EQOL.5D3L questionnaire on long-term quality of life, representing the best prognostic factor—in terms of long-term quality of life—in patients surviving major thoracic trauma surgical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Children with chest wall tumors may require extensive chest wall resections. The reconstruction of large chest wall defects can be surgically challenging. We present a new chest wall reconstruction method. Case presentation: A 2.5-year-old male who developed respiratory symptoms and chest pain was diagnosed with an Askin's tumor of the left chest wall. The tumor originated in the posterior segments of the seventh and eighth ribs. Computed tomography of the chest revealed a large mass filling the left hemithorax, causing flattening of the hemidiaphragm and mediastinal shift. No distant metastases were identified. The patient underwent six cycles of neoadjuvant chemotherapy with vincristine, adriamycin, cyclophosphamide, ifosfamide, and etoposide. Post-chemotherapy, magnetic resonance imaging revealed a significant reduction in tumor size. The patient was taken to the operating room for the resection of the tumor. The posterior segments of the left sixth, seventh, eighth, and ninth ribs were surgically excised. The chest wall was reconstructed using a biological mesh (Permacol™), sutures for costal arch stabilization using the lattice technique, and a rotated latissimus dorsi muscle flap for defect coverage. An 18 Fr pleural drainage was left in place. The patient tolerated the operation well and was successfully extubated 48 hours later. Pain was effectively managed via paravertebral block. The patient was discharged on the 14th postoperative day. The resected specimen had negative margins. He subsequently underwent several more cycles of chemotherapy. Eighteen months after the operation he has developed no scoliosis and has full range of motion on the left chest wall. Conclusion: A combination of a biological mesh, rib stabilization and latissimus dorsi rotation seems to be a valid technique to cover large chest wall defects.

We report a case of massive chest wall bleeding after lung wedge resection caused by a protruding staple. On the third postoperative day, the patient experienced sudden left posterior back pain without any apparent trigger, accompanied by signs of shock. Computed tomography imaging revealed a significant accumulation of blood in the pleural cavity on the side of the surgery. A reoperation was performed, during which we identified active arterial bleeding from a small vessel at the second intercostal space on the posterior chest wall. Hemostasis was achieved using electrocautery. Further examination revealed a protruding staple at the left upper lobe resection margin, which we speculated was likely causing abrasion against the chest wall and leading to the bleeding. This case reveals the potential risk posed by protruding staples. Appropriate precautions should be taken to prevent this rare but dangerous occurrence. [ABSTRACT FROM AUTHOR]

Intercostal lung hernia and inverted intercostal hernia are rare chest wall hernias usually asymptomatic and detected incidentally on chest radiograph. In this case report, we discussed here on the chest radiograph and computed tomography imaging findings of two cases of these rare hernias with an emphasis being in differential diagnosis of chest tumors. [ABSTRACT FROM AUTHOR]

We present a complex case of a patient diagnosed with bilateral breast cancer. The patient initially underwent bilateral skin-sparing mastectomy and immediate subpectoral implant-base breast reconstruction. She had an uncomplicated postoperative recovery. However, three months later, she developed a severe and persistent local infection during adjuvant chemotherapy, resulting in the loss of the breast implants and the formation of massive deforming scars in the chest area. To address this, the patient underwent a series of reconstructive procedures. Lipofilling was used on the chest wall to improve skin quality, followed by a late bilateral transverse rectus abdominis myocutaneous flap for breast reconstruction. Additionally, the final aesthetic result was enhanced by applying a 3-D tattoo. This case highlights the use of a sequence of reconstructive procedures as a feasible alternative to manage complex and extensive scars after failure of primary breast reconstruction. [ABSTRACT FROM AUTHOR]

Chest wall tuberculosis (TB) is often associated with primary pulmonary TB. Primary chest wall TB without any pulmonary involvement is a rare form of musculoskeletal TB and is relatively difficult to diagnose due to nonspecific symptoms. Without significant clinical indications, accepting the possibility of a tubercular origin in chest wall tuberculosis can be challenging, which can mimic a pyogenic abscess or tumor. To rule out potential mycobacterial causes, all abscesses in tuberculosis-endemic areas like India that are resistant to standard therapy must be investigated. Herein, we present a case of primary tuberculosis of the chest wall, which was treated successfully.

Abstract Background Chest wall chondrosarcomas, although common, pose unique challenges due to their aggressive nature, rarity of abdominal wall involvement, and propensity for recurrence. We highlight the critical role of meticulous surgical planning, multidisciplinary collaboration, and innovative reconstruction techniques in achieving optimal outcomes for patients with composite giant chest and abdominal wall chondrosarcoma. Case Presentation A 38-year-old female patient presented with progressive left chest and abdominal wall swelling for two years; on evaluation had a large lobulated lytic lesion arising from the left ninth rib, scalloping eighth and tenth ribs measuring 13.34 × 8.92 × 10.71 cm (anteroposterior/transverse/craniocaudal diameter) diagnosed with chondrosarcoma grade 2. A three-dimensional (3D) composite mesh was designed based on computed tomography using virtual surgical planning and computer-assisted design and manufacturing technology. She underwent wide local excision and reconstruction of the chest and abdominal wall with 3D-composite mesh under general anesthesia. The postoperative condition was uneventful, with no recurrence at 12 months follow-up. Conclusion A 3D-composite mesh facilitates patient-specific, durable, and cost-effective chest and abdominal wall reconstruction.

OBJECTIVES The Haller index (HI) is widely utilized as a quantitative indicator to assess the extent of the pectus excavatum (PE) deformity, which is the most common chest wall abnormality in children. Both preoperative correction planning and postoperative follow-up need to be based on the standard of normal thoracic growth and development. However, there is currently no established reference range for the HI in children. Consequently, the goal of this study was to conduct a preliminary investigation of normal HI values among children to understand thoracic developmental characteristics. METHODS Chest computed tomography images obtained from January 2012 to March 2022 were randomly selected from the imaging system of the Children's Hospital of Chongqing Medical University. We divided the images of children into a total of 19 groups: aged 0–3 months (1 group), 4–12 months (1 group) and 1 year to 17 years (17 groups), with 50 males and 50 females, totaling 100 children in each group. HI was measured in the plane where the lowest point of the anterior thoracic wall was located and statistically analysed using SPSS 26.0 software. RESULTS A total of 1900 patients were included in the study. Our results showed that HI, transverse diameter and anterior-posterior diameter were positively correlated with age (P  <   0.05). Using age as the independent variable and HI as the dependent variable, the best-fit regression equations were HI-male = 2.047 * Age0.054(R2 = 0.276, P<0.0001) and HI-female = 2.045 * Age0.067(R2 = 0.398, P<0.0001). Males had significantly larger thoracic diameters than females, and there was little difference in the HI between the 2 sexes. CONCLUSIONS The HI rapidly increases during the neonatal period, slowly increases during infancy and stops increasing during puberty, with no significant differences between the sexes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Chest wall defect reconstruction is a complex procedure aimed at restoring thoracic structural integrity after trauma, tumor removal, or congenital issues. In this study, postoperative complications were investigated to improve the care of patients with these critical conditions. Materials and Methods: A retrospective study of chest wall reconstructions from 2004 to 2023 was conducted at Klinikum Nürnberg and Evangelisches Waldkrankenhaus Spandau—Berlin. Data included patient demographics, comorbidities, defect etiology, surgery details, and complications using the Clavien–Dindo classification. Results: Among the 30 patients included in the study, a total of 35 complications occurred in 35 thoracic wall defect reconstructions. These complications were classified into 22 major and 13 minor cases. Major complications were more common in patients with cancer-related defects, and considerable variations were observed between free flap and pedicled flap surgeries. Notably, the use of the anterolateral thigh (ALT) flap with vastus lateralis muscle demonstrated promise, exhibiting fewer complications in select cases. The reconstruction of chest wall defects is associated with substantial complications regardless of the etiology of the defect and the particular surgical procedure used. Interestingly, there was a lower complication rate with free flap surgery than with pedicled flaps. Conclusions: The ALT flap with vastus lateralis muscle deserves further research in this field of reconstruction. Multidisciplinary approaches and informed patient discussions are crucial in this complex surgical field, emphasizing the need for ongoing research and technique refinement. [ABSTRACT FROM AUTHOR]

Background: Thoracic epidural analgesia (TEA) is used for analgesia following lower abdomen or orthopaedic surgeries. The aim of study was To compare the effects of 0.125% Bupivacaine with 2mcg/ml of Fentanyl infusion (group A) and 0.125% Bupivacaine with fentanyl patch (group B). Methods: Patients undergoing elective surgery were randomized in a non-blinded fashion to receive postoperative analgesia at a single teaching hospital. A nested qualitative study (reported elsewhere) explored the dual primary outcome of patient experience and acceptability. Secondary outcome measures included rest and movement pain scores over 72 h, functional analgesia, analgesia satisfaction, opiate consumption, functional recovery, morbidity, safety, and cost-effectiveness. Results: A total of 40 patients were randomized. The median (interquartile range; i.q.r.) dynamic pain score at 24 h was significantly lower after TEA than RSCA (33 (11–60) versus 50.5 (24.50–77.25); P=0.018). Resting pain score at 72 h was significantly lower (4.5 (0.25–13.75) versus 12.5 (2–13); P=0.019). Opiate consumption on postoperative day 3 (median (i.q.r.) morphine equivalent 17 (10–30) mg versus 40 (13.25–88.50) mg; P=0.038), hypotension, or vasopressor dependency (29.7 versus 49.2 per cent; P=0.023) and weight gain to day 3 (median (i.q.r.) 0 (−1–2) kg versus 1 (0–3) kg; P=0.046) were all significantly greater after TEA. Conclusions: TEA provided superior initial postoperative analgesia but only for the first 24 h. By 72 hours and provides superior analgesia, is associated with a lower incidence of unwanted effects, and may be more costeffective. [ABSTRACT FROM AUTHOR]

Background: Chest wall chondrosarcomas, although common, pose unique challenges due to their aggressive nature, rarity of abdominal wall involvement, and propensity for recurrence. We highlight the critical role of meticulous surgical planning, multidisciplinary collaboration, and innovative reconstruction techniques in achieving optimal outcomes for patients with composite giant chest and abdominal wall chondrosarcoma. Case Presentation: A 38-year-old female patient presented with progressive left chest and abdominal wall swelling for two years; on evaluation had a large lobulated lytic lesion arising from the left ninth rib, scalloping eighth and tenth ribs measuring 13.34 × 8.92 × 10.71 cm (anteroposterior/transverse/craniocaudal diameter) diagnosed with chondrosarcoma grade 2. A three-dimensional (3D) composite mesh was designed based on computed tomography using virtual surgical planning and computer-assisted design and manufacturing technology. She underwent wide local excision and reconstruction of the chest and abdominal wall with 3D-composite mesh under general anesthesia. The postoperative condition was uneventful, with no recurrence at 12 months follow-up. Conclusion: A 3D-composite mesh facilitates patient-specific, durable, and cost-effective chest and abdominal wall reconstruction. [ABSTRACT FROM AUTHOR]

Cold abscess of the chest wall is an uncommon disease that is mainly caused by tuberculous infection. Staphylococcal cold abscesses of the chest wall are extremely rare and usually clinically occult, frequently leading to a delay in diagnosis and consequently severe infectious complications. We report an 88-year-old woman with end-stage renal disease, who presented with an exit site infection of a cuffed tunneled dialysis catheter caused by methicillin-resistant Staphylococcus aureus (MRSA). Despite the removal of the catheter and administration of antibiotics, she developed refractory MRSA bacteremia. Computed tomography (CT) of the chest revealed septic thrombophlebitis with metastatic cold abscesses of the chest wall and ribs destruction. Although CT-guided drainage and vancomycin therapy eliminated MRSA bacteremia, the chest wall abscesses did not resolve. Patients fitted with a central venous dialysis catheter are at risk of septic thrombophlebitis with metastatic cold abscesses of the chest wall that are resistant to antibiotic therapy. Early identification is based on serial blood cultures and prompt CT scans. Surgical management coupled with antibiotic therapy can eradicate the source of infection and improve patients' outcomes. [ABSTRACT FROM AUTHOR]

Osteosarcoma is the most common tumour that develops in the chest wall of dogs; an extensive excision is the treatment of choice. Various methods have been reported for reconstruction of chest wall defects following extensive excision. The objective of this report was to describe the complete resection of an extensive costal osteosarcoma with an extended resection of the ribs and part of the diaphragm in a dog. An 11‐year‐old neutered, male, miniature pinscher was presented with dyspnoea: An extensive mass was observed, stretching from the right chest wall to the abdominal wall. On computed tomography, the mass originated from the right 9th rib and exceeded the 6th rib on the cranial side and the 13th rib on the caudal side; it was compressing the lungs, diaphragm, liver, stomach and duodenum. When the patient's condition was medically stabilized, the tumour was removed from the right 9th rib. In consideration of the surgical margin, the 5th–13th ribs were excised, and the tumour was resected with the thoracoabdominal wall and part of the diaphragm. The missing thoracoabdominal wall and section of the diaphragm were reconstructed using two sheets of a polypropylene mesh. Postoperatively, flail chest was observed, although dyspnoea was not observed in the patient. Histopathological examination confirmed the diagnosis of osteosarcoma with a clean margin. Although 60.6 months have passed post‐surgery, no metastasis has reoccurred. In this case, complete resection and reconstruction of the chest wall and diaphragm were achieved using a polypropylene mesh without fatal postoperative complications, despite extensive osteosarcoma resection. [ABSTRACT FROM AUTHOR]

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Typhoid fever remains prevalent in Pakistan, with Salmonella Typhi, the causative bacterium, known to occasionally trigger uncommon extra-intestinal ailments. The identification of a focal Salmonella infection poses a frequent challenge. This case report details an instance of an extensively drug-resistant Salmonella infection affecting the soft tissue in the anterior chest wall, effectively managed with antibiotic treatment. Our emphasis is on recognizing the importance of considering focal Salmonella infection as part of the differential diagnosis when confronted with a chronic abscess of unknown origin.

Abstract Lymphoid follicular hyperplasia (LFH) is a benign lymphoproliferative disease. Although it can occur within the thoracic cavity, LFH originating from the chest wall has not been reported. A 79‐year‐old woman was incidentally found to have a well‐defined mass on the left posterior chest wall during a preoperative examination for aortic valve replacement. The mass had slowly grown over 6 years. Thoracoscopic surgical resection was performed without complications. Pathological examination ruled out lymphoproliferative diseases, such as Castleman disease or malignant lymphoma, and a diagnosis of LFH was made. Although LFH generally has a good prognosis, surgical resection is recommended for diagnostic and therapeutic purposes owing to the possibility of malignancy masquerading as a reactive lesion. This is the first report of an LFH arising from the chest wall with imaging findings similar to other benign tumours. Its potential as a differential diagnosis for tumours with similar imaging findings is highlighted.

Breathing motion is based on the differential activity of the thoracic, diaphragmatic and abdominal muscles. Muscle contributions differ between rest and exercise conditions and depend on posture and other factors. Traditionally, these changes are investigated on volumetric data using optoelectronic plethysmography (OEP). OEP offers insight into size variations of different chest wall (CW) compartments but does not provide three-dimensional visualization methods of CW breathing kinematics. Here we explore the use of three-dimensional geometric morphometrics to analyse size and shape changes caused by spontaneous breathing motion during quiet (QB), and recovery breathing (REC, immediately after heavy exercise) in two different postures (SIT, sitting on cycle ergometer; STA, standing position). Our findings show that size and shape differ significantly between inspiration and expiration and that differences are greater in REC than in QB. However, this is achieved by stronger expiration in SIT but by greater expiratory and inspiratory movements in STA. Shape analysis suggests that these differences may be attributed to constrained mobility of the shoulder girdle and a minor thoracic spine extension during inspiration owing to position on the ergometer. Breathing motion in STA seems biomechanically less constrained. Geometric morphometrics analyses can provide additional insights into data obtained by OEP.

Background: The effect of position and gender on chest movements and respiratory volumes is controversial and investigated in only a few studies.Objective: This study aimed to investigate the effects of position and gender on the breathing pattern during four different positions in healthy individuals.Material and Methods: In this cross-sectional study, twenty-eight (14 males, 14 females) healthy individuals participated aged 20-45 years. The optoelectronic plethysmography (OEP) method was used for the three-dimensional evaluation of chest wall motions and the compartmental analysis of the breathing pattern in supine, sitting, standing, and active straight leg raised (ASLR) positions. Volume changes in different parts of the chest wall were also measured.Results: Position affected total and compartmental respiratory volumes in both genders. Respiratory volumes decreased in the supine position compared to sitting and standing. Total and abdominal respiratory volumes also decreased in females when comparing supine positions with the ASLR. A higher pulmonary rib cage contribution was identified in females, and males exhibited higher abdominal rib cage volume compared with females. Conclusion: The breathing pattern was affected by position and gender, and the respiratory volumes increased in more upright positions, perhaps due to a greater gravitational load. The ASLR decreases the respiratory volume, which is probably due to increased postural demand.

Abstract Background Chest wall lesions comprise benign and malignant etiologies. Numerous classification systems have been proposed based on etiology, origin site, tissue composition and whether the lesion is benign or malignant. Despite that conventional radiological studies are able to provide detailed information about the tumor morphology such as size, location, and extent tissue characteristics, yet, they cannot reliably differentiate benign from malignant neoplasms. This study aimed to detect the diagnostic value of diffusion weighted MRI and PET/CT in evaluating chest wall lesions, and in differentiating benign from malignant lesions. Results The chest wall lesions were divided into either benign or malignant; 34 cases (47.9%) were diagnosed as benign, while 37 cases (52.1%) were diagnosed as malignant. The mean ADC value of malignant lesions (0.8 ± 0.3 × 10–3 mm2/s) was significantly lower than that of benign lesions (1.3 ± 0.6 × 10–3 mm2/s). This yielded statistically significant results with cut off value of 1.25 × 10–3 mm2/s for confident diagnosis and differentiation of benign from malignant lesions, with sensitivity of 91.9%, specificity of 70.6%, positive predictive value of 77.27%, negative predictive value of 88.89% and accuracy of 81.7%. The mean SUV of malignant lesions (14.2 ± 6.1) was significantly higher than that of benign lesions (1.5 ± 1.3). This yielded statistically significant results with cut off value of 2.45 for confident diagnosis and differentiation of benign from malignant lesions, with sensitivity of 100%, specificity of 82.4%, positive predictive value of 86.05%, negative predictive value of 100%, and accuracy of 91.5%. Conclusions Both DWI-MRI and PET/CT can reliably differentiate benign from malignant lesions, yet, PET/CT showed higher sensitivity, specificity and accuracy.

Chest wall tuberculosis (TB) is often associated with primary pulmonary TB. Primary chest wall TB without any pulmonary involvement is a rare form of musculoskeletal TB and is relatively difficult to diagnose due to nonspecific symptoms. Without significant clinical indications, accepting the possibility of a tubercular origin in chest wall tuberculosis can be challenging, which can mimic a pyogenic abscess or tumor. To rule out potential mycobacterial causes, all abscesses in tuberculosis-endemic areas like India that are resistant to standard therapy must be investigated. Herein, we present a case of primary tuberculosis of the chest wall, which was treated successfully. [ABSTRACT FROM AUTHOR]

Lymphoid follicular hyperplasia (LFH) is a benign lymphoproliferative disease. Although it can occur within the thoracic cavity, LFH originating from the chest wall has not been reported. A 79‐year‐old woman was incidentally found to have a well‐defined mass on the left posterior chest wall during a preoperative examination for aortic valve replacement. The mass had slowly grown over 6 years. Thoracoscopic surgical resection was performed without complications. Pathological examination ruled out lymphoproliferative diseases, such as Castleman disease or malignant lymphoma, and a diagnosis of LFH was made. Although LFH generally has a good prognosis, surgical resection is recommended for diagnostic and therapeutic purposes owing to the possibility of malignancy masquerading as a reactive lesion. This is the first report of an LFH arising from the chest wall with imaging findings similar to other benign tumours. Its potential as a differential diagnosis for tumours with similar imaging findings is highlighted. [ABSTRACT FROM AUTHOR]

Intercostal lipomas are rare benign tumors that predominantly occur in the subcutaneous tissue. However, intramuscular intercostal lipomas are exceedingly uncommon and pose diagnostic challenges due to their atypical presentation. Here, we present a case report of an intramuscular intercostal lipoma located in the left axillary tail, along with a comprehensive discussion of its clinical features, diagnostic evaluation, and management options.

A 6-year-old castrated male mixed dog presented with a rapidly growing mass at the right chest wall two weeks after initial detection. A mesenchymal origin of the malignancy was suspected based on fine-needle aspiration. Computed tomography (CT) revealed that the mass originated from the right chest wall and protruded externally (6.74 × 5.51 × 4.13 cm3) and internally (1.82 × 1.69 × 1.50 cm3). The patient revisited the hospital because of breathing difficulties. Radiography confirmed pleural effusion, and ultrasonography-guided thoracocentesis was performed. The effusion was hemorrhagic, and microscopic evaluation showed no malignant cells. Before surgery, CT without anesthesia was performed to evaluate the status of the patient. The 7–10th ribs were en bloc resected at a 3-cm margin dorsally and ventrally, and two ribs cranially and caudally from the mass. After recovering the collapsed right middle lobe of the lung due to compression from the internal mass with positive-pressure ventilation, a 3D-printed bone model contoured titanium mesh was tied to each covering rib and surrounding muscles using 2-0 blue nylon and closed routinely. The thoracic cavity was successfully reconstructed, and no flail chest was observed. The patient was histo-pathologically diagnosed with extraskeletal osteosarcoma. A CT scan performed 8 months after surgery showed no evident recurrence, metastasis, or implant failure. This is the first case report of chest wall reconstruction using titanium mesh in a dog. The use of a titanium mesh allows for the reconstruction of extensive chest wall defects, regardless of location, without major postoperative complications.

Objective: To describe and analyze MRI findings in suspected early fractures of the chest (ribs and sternum) and assess if this technique can add value in occupational medicine. Materials and methods: In this retrospective study, we reviewed 112 consecutive patients with work-related mild closed chest trauma who underwent early thoracic MRI, when there was not a clear fracture on radiograph or when the symptoms were intense and not explained by radiographic findings. MRI was evaluated by two experienced radiologists independently. The number and location of fractures and extraosseous findings were recorded. A multivariate analysis was performed to correlate the fracture characteristics and time to RTW (return-to-work). Interobserver agreement and image quality were assessed. Results: 100 patients (82 men, mean age 46 years, range 22–64 years) were included. MRI revealed thoracic wall injuries in 88%: rib and/or sternal fractures in 86% and muscle contusion in the remaining patients. Most patients had multiple ribs fractured, mostly at the chondrocostal junction (n=38). The interobserver agreement was excellent, with minor discrepancies in the total number of ribs fractured. The mean time to return-to-work was 41 days, with statistically significant correlation with the number of fractures. Time to return-to-work increased in displaced fractures, sternal fractures, extraosseous complications, and with age. Conclusion: Early MRI after work-related chest trauma identifies the source of pain in most patients, mainly radiographically occult rib fractures. In some cases, MRI may also provide prognostic information about return-to-work. [ABSTRACT FROM AUTHOR]

Background: Chest wall lesions comprise benign and malignant etiologies. Numerous classification systems have been proposed based on etiology, origin site, tissue composition and whether the lesion is benign or malignant. Despite that conventional radiological studies are able to provide detailed information about the tumor morphology such as size, location, and extent tissue characteristics, yet, they cannot reliably differentiate benign from malignant neoplasms. This study aimed to detect the diagnostic value of diffusion weighted MRI and PET/CT in evaluating chest wall lesions, and in differentiating benign from malignant lesions. Results: The chest wall lesions were divided into either benign or malignant; 34 cases (47.9%) were diagnosed as benign, while 37 cases (52.1%) were diagnosed as malignant. The mean ADC value of malignant lesions (0.8 ± 0.3 × 10–3 mm2/s) was significantly lower than that of benign lesions (1.3 ± 0.6 × 10–3 mm2/s). This yielded statistically significant results with cut off value of 1.25 × 10–3 mm2/s for confident diagnosis and differentiation of benign from malignant lesions, with sensitivity of 91.9%, specificity of 70.6%, positive predictive value of 77.27%, negative predictive value of 88.89% and accuracy of 81.7%. The mean SUV of malignant lesions (14.2 ± 6.1) was significantly higher than that of benign lesions (1.5 ± 1.3). This yielded statistically significant results with cut off value of 2.45 for confident diagnosis and differentiation of benign from malignant lesions, with sensitivity of 100%, specificity of 82.4%, positive predictive value of 86.05%, negative predictive value of 100%, and accuracy of 91.5%. Conclusions: Both DWI-MRI and PET/CT can reliably differentiate benign from malignant lesions, yet, PET/CT showed higher sensitivity, specificity and accuracy. [ABSTRACT FROM AUTHOR]

Desmoid fibromatosis (DF) is a connective tissue tumor that grows aggressively in musculoaponeurotic tissues. It has an annual incidence rate of 2–4/million and is commonly seen in individuals aged 15 to 60 years, with female predominance. While it can occur in any body part, it is commonly found in the extremities, abdominal wall, and abdominal mesentery. But it rarely develops in the chest wall. The cause of the tumor is unknown. However, trauma to the tumor site has been identified in 25% of known cases. The primary treatment is surgical resection. Local recurrence after surgical excision is common. Our study highlights the case of a 12-year-old male patient diagnosed with a desmoid tumor on the chest wall 2 years ago, at the age of 10 years, after mild trauma. The tumor was successfully managed with surgery without radiotherapy treatment and no recurrence was observed in the last 2 years. [ABSTRACT FROM AUTHOR]

Background: The effect of position and gender on chest movements and respiratory volumes is controversial and investigated in only a few studies. Objective: This study aimed to investigate the effects of position and gender on the breathing pattern during four different positions in healthy individuals. Material and Methods: In this cross-sectional study, twenty-eight (14 males, 14 females) healthy individuals participated aged 20-45 years. The optoelectronic plethysmography (OEP) method was used for the three-dimensional evaluation of chest wall motions and the compartmental analysis of the breathing pattern in supine, sitting, standing, and active straight leg raised (ASLR) positions. Volume changes in different parts of the chest wall were also measured. Results: Position affected total and compartmental respiratory volumes in both genders. Respiratory volumes decreased in the supine position compared to sitting and standing. Total and abdominal respiratory volumes also decreased in females when comparing supine positions with the ASLR. A higher pulmonary rib cage contribution was identified in females, and males exhibited higher abdominal rib cage volume compared with females. Conclusion: The breathing pattern was affected by position and gender, and the respiratory volumes increased in more upright positions, perhaps due to a greater gravitational load. The ASLR decreases the respiratory volume, which is probably due to increased postural demand. [ABSTRACT FROM AUTHOR]

Key clinical message: Unicentric Castleman disease, particularly the hypervascular variant subtype, commonly presents as a localized lymphadenopathy without systemic symptoms. Surgical excision is often curative for this subtype, leading to a good prognosis. However, some patients with autoimmune complications may require additional systemic therapy along with surgery. Accurate diagnosis through a combination of clinical, radiological, and pathological findings is crucial for optimal management. [ABSTRACT FROM AUTHOR]

Primary spontaneous pneumothorax (PSP) primarily affects slim and tall young males. Exploring the etiological link between chest wall structural characteristics and PSP is crucial for advancing treatment methods. In this case-control study, chest computed tomography (CT) images from patients undergoing thoracic surgery, with or without PSP, were analyzed using Artificial Intelligence. Convolutional Neural Network (CNN) model of EfficientNetB3 and InceptionV3 were used with transfer learning on the Imagenet to compare the images of both groups. A heatmap was created on the chest CT scans to enhance interoperability, and the scale-invariant feature transform (SIFT) was adopted to further compare the image level. A total of 2,312 CT images of 26 non-PSP patients and 1,122 CT images of 26 PSP patients were selected. Chest-wall apex pit (CAP) was found in 25 PSP and three non-PSP patients (p