Subacute Sternal Mass in Childhood

Verhaeghe, L; Herman, Murielle

doi:10.5334/jbsr.1715

Cited by 2 publications

(6 citation statements)

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“…Our case series had similar sonographic findings to other reports. 2,4,5,7 Although CT and MRI clearly depicted the morphology and the extent of the lesion, no additional information was obtained over that already suspected based on the chest radiographs and ultrasounds. Important differential diagnoses include, but are not limited to, infectious and neoplastic lesions such as Ewing sarcoma, rhabdomyosarcoma, Langerhans cell histiocytosis (LCH) and infantile fibrosarcoma, 1,8 although primary sternal tumours in young children are extremely rare.…”

Section: Discussionmentioning

confidence: 99%

Sonographic features of sternal pseudotumour in children

Gerrie,

Watson,

Morreau

2024

Australas J Ultrason Med

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IntroductionSternal pseudotumour is an important but rare entity thought to be an inflammatory, non‐neoplastic lesion that can mimic tumours. The purpose of this paper was to illustrate the imaging features of this lesion to avoid unnecessary investigations.MethodsThe clinical notes and imaging features of four patients with a diagnosis of sternal pseudotumour were reviewed over a period from February 2016 to July 2019.ResultsAll patients were afebrile with no history of trauma. The median age at presentation was 12.5 months. The median length of symptoms prior to presentation was 3.5 days. One patient had a mildly elevated C‐reactive protein. Chest radiographs showed a pre‐sternal soft‐tissue mass, with or without osseous destruction of the subjacent sternum. Ultrasound showed a heterogeneous, hypoechoic pre‐sternal soft‐tissue mass with variable internal vascularity with extension between sternal ossification centres. CT and MRI showed an enhancing dumbbell‐shaped lesion with a pre‐sternal and retro‐sternal soft‐tissue component. The median time to complete resolution was 3 months. One patient had a biopsy that showed chronic inflammation and fibrosis.DiscussionThese lesions present in young children typically with a 1‐ to 2‐week history of a focal 2‐ to 4‐cm swelling over the sternum. The aetiology is unknown but may be on the basis of a yet‐to‐be identified pathogen. Inflammatory markers and cultures are normal or mildly elevated. Important differential considerations include sternal osteomyelitis or neoplastic causes such as Ewing sarcoma, rhabdomyosarcoma, Langerhans cell histiocytosis and infantile fibrosarcoma.ConclusionSternal pseudotumor is a rare but important entity to be aware of to avoid unnecessary invasive biopsy or further investigations. Our suggestion is that this is a ‘Don't touch’ lesion that requires close short‐interval follow‐up at a surgical outpatient clinic and with ultrasound until resolution.

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Section: Discussionmentioning

confidence: 99%

Sonographic features of sternal pseudotumour in children

Gerrie,

Watson,

Morreau

2024

Australas J Ultrason Med

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“…To prevent unnecessary biopsy, treatment with antibiotics and invasive surgery, physicians must be familiar with the entity known as SELSTOC. [1][2][3][4] This selfinvoluting tumor originates from an exacerbated immune response to an aseptic inflammatory process. 1,4 It is not associated with prior trauma.…”

mentioning

confidence: 99%

“…4 Ultrasound examination, considered to be the most appropriate imaging examination for the diagnosis of SEL-STOC, typically shows a lesion with a hypoechoic and inhomogeneous aspect, usually dumbbell shaped, involving (or in contact with) the sternal and/or costal cartilages, with presternal/parasternal and retrosternal/mediastinal components. [1][2][3][4] Color Doppler ultrasound examination shows no significant internal vascularity. 2,3 There are few data on the MRI characteristics of SEL-STOC.…”

mentioning

confidence: 99%

“…[1][2][3][4] Color Doppler ultrasound examination shows no significant internal vascularity. 2,3 There are few data on the MRI characteristics of SEL-STOC. In our case, the restricted diffusion of the lesion drew attention; this characteristic should not be misinterpreted as representing malignancy or infectious abscess.…”

mentioning

confidence: 99%

“…3,4 Follow-up with ultrasound examination is recommended. [2][3][4] In contrast with benign masses, malignant sternal/parasternal lesions show aggressive signs of destruction and invasion of neighboring structures, and tend to increase in size over time. 3,4 In summary, the combination of young age (ie, infancy or childhood), sternum-related localization, rapid growth, typical imaging findings (ie, dumbbell-shaped appearance), lack of general illness, and lack of other abnormalities on physical examination justifies the adoption of a conservative (wait-and-see) approach.…”

mentioning

confidence: 99%

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