1 thought on “Incidental chest wall mass 37F dentist Ultrasound, Please Help”
hilary.umans
Ironically, though I reported the case at the end of yesterday workday, I
found it unsigned in my list this AM because of a Powerscribe glitch.
Though I had come to the same conclusion yesterday…considering the many
opinions and reconsidering the US and physical exam findings in the context
of the confusing MRi—-but a good night’s sleep and reassuring comments
from Jonathan Tresley allowed me to formulate a more cohesive and useful
report.
I decided to stick with “location, location, location”…despite the fact
there is no demonstrable fat signal, it seems to be superficial to the rib
and deep to the serratus in the US….and dives deep to the inferior
scapular margina—–so I favor an atypical elastofibroma dorsi—–in a
very thin patient….which is why it was palpated during the massage (as
she was prone, with her scapula elevated and rotated out of the way).
Alternatively, it could be an inflamed muscle (serratus ant ?) or
desmoid….or something else iso-signal to muscle that I can’t think of.
The point was well taken, that it is superficial and easily needled—-and,
based on my interaction, I don’t think she will tolerate clinical and
imaging follow-up.
So I offered clinical and imaging (US or MRI) follow-up, but suggested that
biopsy would provide more immediate and definitive diagnosis.
We shall see…maybe.
Thank you for your advice….really very helpful.
Ironically, though I reported the case at the end of yesterday workday, I
found it unsigned in my list this AM because of a Powerscribe glitch.
Though I had come to the same conclusion yesterday…considering the many
opinions and reconsidering the US and physical exam findings in the context
of the confusing MRi—-but a good night’s sleep and reassuring comments
from Jonathan Tresley allowed me to formulate a more cohesive and useful
report.
I decided to stick with “location, location, location”…despite the fact
there is no demonstrable fat signal, it seems to be superficial to the rib
and deep to the serratus in the US….and dives deep to the inferior
scapular margina—–so I favor an atypical elastofibroma dorsi—–in a
very thin patient….which is why it was palpated during the massage (as
she was prone, with her scapula elevated and rotated out of the way).
Alternatively, it could be an inflamed muscle (serratus ant ?) or
desmoid….or something else iso-signal to muscle that I can’t think of.
The point was well taken, that it is superficial and easily needled—-and,
based on my interaction, I don’t think she will tolerate clinical and
imaging follow-up.
So I offered clinical and imaging (US or MRI) follow-up, but suggested that
biopsy would provide more immediate and definitive diagnosis.
We shall see…maybe.
Thank you for your advice….really very helpful.
Hilary
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