Tumores Benignos do Tórax

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Tumores Benignos do Tórax Caso 01 
• 67 year old with cough and fever 
 
Anatomia Normal 
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Opções 
A. Hiatal hernia (estômago projeta-se 
através do hiato do diafragma) 
B. TB 
C. Bronchogenic carcinoma 
D. Sarcoidosis 
E. Lung abscess 
Lung Abscess 
• Cavitary lung lesions produced by infectious 
agents 
• They may be consequences of aspiration (most 
commonly) or pneumonia or they may be 
secondary to bronchial obstruction, 
bronchiectasis, bacterial endocarditis or spread 
of infection from elsewhere in the lung 
Achados em Imagem - CXR 
 
▫ Usually single cavity 
▫ Cavities typically have a 
 Thick-wall (which may become thinner as the 
surrounding inflammation resolves) 
 Smooth inner margin 
 Air-fluid level 
▫ More frequent in superior segments of lower lobes or 
posterior segments of lower lobes 
▫ Unlike pleural collections, lung abscesses frequently 
have a fluid level which is approximately the same 
length on both the frontal and lateral projection 
▫ About 1/3 may have an associated empyema 
Achados em Imagem - CT 
• Helpful in differentiating between a lung abscess 
and an empyema 
• Cavity may be seen as rounded with a thick wall 
and an air-fluid level 
• Lung abscesses, being intraparenchymal, form 
an acute angle where they meet the chest wall 
 
Lung abscess. A single, contrast-enhanced axial CT scan inage of the chest shows a 
large cavitary lesion in the left lower lobe with a relatively thick wall(black arrows). The 
cavity has a smooth inner margin and an air-fluid level (white arrow). There is 
inflammatory reaction in the surroundig lung (yellow arrow). Notice the acute angle the 
abscess makes with the posterior chest wall. 
Caso 02 
• 51 year-old woman with chest pain 
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Anatomia Normal 
Anatomia Normal 
Opções 
A. Lipoma 
B. Pseudotumor 
C. Lymphoma 
D. Localized Fibrous Tumor of Pleura 
E. Hamartoma 
Localized Fibrous Tumor of the Pleura 
• (AKA Solitary Fibrous Tumor of the Pleura, Benign 
Mesothelioma, Pleural Fibroma) 
• General Considerations 
• Rare, mesenchymal primary tumors of the visceral 
pleura less common than diffuse malignant 
mesothelioma 
• Localized form is less common and not related to 
asbestos exposure or smoking 
• LFTP can be either benign or malignant but is much 
more often benign (7:1) 
• Usually patients are >50 years old 
• Most occur in the inferior portions of the hemithoraces 
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Achados em CXR 
• Well-circumscribed soft tissue mass with 
sharp margin applied to a pleural surface, 
including the fissures 
• Angle it makes with chest wall may be acute or 
obtuse 
• They can grow very large and occupy half the 
hemithorax 
Achados em CT 
• Soft-tissue mass applied to pleural surface 
• May have a lobulated contour 
• Avidly enhances but may have lower attenuation 
areas of necrosis or hemorrhage, especially in larger 
lesions 
• At least one angle with pleura is more often acute 
• May have small effusion 
• Calcification is rare 
• May have a pedicle that attached tumor to pleura 
• Malignant lesions are more often large and have 
necrosis 
Localized Fibrous Tumor of the Pleura. Upper photo. Large, pleural-based soft 
tissue mass abuts pleura in right lower lung with an acute angle (white arrow) and 
obtuse angle (yellow arrow) where it meets the chest wall. Lower photo: Mediastinal 
windows show heterogeneous nature of the contrast-enhancing mass with some areas of 
lower attenuation (blue arrows) most likely representing necrosis. 
Localized Fibrous Tumor of the Pleura. Upper photo. Large, pleural-based soft 
tissue mass abuts pleura in right lower lung with an acute angle (white arrow) and 
obtuse angle (yellow arrow) where it meets the chest wall. Lower photo: Mediastinal 
windows show heterogeneous nature of the contrast-enhancing mass with some areas of 
lower attenuation (blue arrows) most likely representing necrosis. 
Caso 03 
 
Anatomia Normal 
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Opções 
• A. Squamous cell carcinoma 
• B. Lipoid pneumonia 
• C. AVM (Malformação arteriovenosa) 
• D. Hamartoma 
Hamartoma of the Lung 
• Hamartoma is composed of tissues normally found 
in the location of origin but in abnormal quantity, 
mixture or arrangement. 
 
 
• Hamartoma of the right lung seen on 
CT contains both calcification and fat 
 
• OBS.: DDX: Squamous cell carcinoma – pode ser 
um NPS periférico, mas cavita secundariamente à 
necrose 
 
Características 
• Location 
• • 2/3 are peripheral 
• • Endobronchial in 10% 
• • Rarely multiple 
• Findings 
• • Round, smooth mass - increase in size 
slowly 
• • Calcification in 15% - pathognomonic 
if popcorn type 
• • Fat in 50% - detected by CT 
• • Calcium and fat in only 20% 
• • Cavitation extremely rare 
 
DDX 
• • Some other causes of a solitary pulmonary nodule 
• • Bronchial adenoma 
• • Bronchogenic carcinoma 
• • Granuloma 
• • Lipoid pneumonia (both contain fat but lipid 
pneumonia is less well-circumscribed and usually does 
not contain calcification) 
• • Solitary metastasis 
• • Arteriovenous malformation (homogeneous, well-
circumscribed, non-calcified nodule up to several 
centimeters in diameter or the presence of a serpiginous 
mass connected with blood vessels) 
• • Necrobiotic nodule 
 
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Caso 04 
 
Opções 
• A. Aspirated walnut 
• B. Pneumonia 
• C. Pseudotumour 
• D. Artifact 
Pseudotumour 
• Frontal and lateral views of an 89 year-old 
female with an oval soft tissue density 
superimposed on the minor fissure on both the 
frontal and lateral views. The lesion has slight 
"points" where it abuts the minor fissure, a sign 
of a "pseudotumour" or "vanishing tumour" in 
the minor fissure. There are usually more signs 
associated with congestive heart failure than 
are seen in this patient. 
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Pseudotumour / Vanishing Tumor of 
the Lung 
• Sharply marginated collection of pleural fluid 
contained either within an interlobar pulmonary 
fissure or in a subpleural location adjacent to a 
fissure 
• Result from transudation from the pulmonary 
vascular space 
• Commonly manifest as incidental radiographic 
findings in patients with congestive heart failure 
▫ Other causes of transudates include 
 Hypoalbuminemia 
 Renal insufficiency 
 
Caso 05 
 
Opções 
• A. Round pneumonia 
• B. Thyroid goiter (bócio) 
• C. Pericardial cyst 
• D. Left ventricular aneurysm 
Pericardial Cyst 
• Fluid-filled cysts of the parietal pericardium consisting of a single 
layer of mesothelial cells 
• Usually discover at age 30-40 years, predominantly in males (3:2) 
• Most are asymptomatic and incidental findings 
• Atypical chest pain can occur 
• They are usually (75%) located at the cardiophrenic angle almost 
always on the right (3:1) 
▫ DDX of a right cardiophrenic angle mass 
 Pericardial cyst 
 Sequestration 
 Foramen of Morgagni hernia 
• They can occur higher and may extend into major fissure 
▫ Classically they are soft and can be flattened on the edge that faces the 
fissure 
• They rarely occur in the mediastinum 
 
 
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Achados em Imagem 
• Pericardial Cyst. Frontal and lateral views of the chest 
demonstrate a mass at the right cardiophrenic angle with 
rim-like calcification that indicates the calcification has 
formed in the wall of a hollow viscus. This is a characteristic 
location for a pericardial cyst, which is calcified in this case.• Sharply marginated 
• Round or oval mass 
• From 3-8 cm in size usually 
• They can change in size and shape with respiration or body 
position 
• Rarely calcify 
• On CT, their attenuation values of 20-40 HU, occasionally 
higher 
 
CASO 06 
• Mulher de 62 anos com enfisema 
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Opções 
A. Actinomicose 
B. Capa pleural apical 
C. Tuberculose “antiga” (curada) 
D. Metastases 
E. Lipoma Pleural 
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Opções 
A. Actinomycosis (infecção bacteriana – causa 
abcessos pulmonares ou cavidades pulmonares) 
B. Apical Pleural Cap (densidade curva no ápice 
pulmonar) 
C. Old Tuberculosis (nódulos pulmonares para-hilares 
ou nos lobos superiores) 
D. Metastasis (são associadas com destruição de 
costelas) 
E. Pleural Lipoma (lesões convexas de crescimento 
lento que formam ângulos obtusos com a pleura) 
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Lipoma pleural 
(Considerações Gerais) 
• Tumor benigno da pleura mais comum 
• Acredita-se que origina-se na pleura parietal 
estendendo-se aos espaços subpleurais, pleurais 
ou extrapleurais. 
• Lento crescimento, encapsulado 
• Pode tornar-se razoavelmente grande 
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Pleural Lipoma. Above: White arrow points to a soft tissue mass in the 
right lung apex along the lateral chest wall which forms obtuse angles where 
it meets the chest wall (yellow arrows) suggesting a pleural or extrapleural 
location. 
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Caso 07 
• 37 year old with hemoptysis 
3d Rendering in the Axial Plane of a Chest CT 
Opções 
A. Anemia 
B. Bronchogenic carcinoma 
C. Pseudoaneurysm 
D. Arteriovenous malformation 
E. Pulmonary embolism 
 
Pulmonary Arteriovenous 
Malformations (AVM) 
• Defect in capillary structure 
▫ Usually congenital in origin 
• Can also be acquired in 
▫ Cirrhosis 
▫ Cancer 
▫ Trauma 
▫ Surgery 
▫ Actinomycosis 
▫ Schistosomiasis 
• Hemangioma of cavernous type 
• Age 
▫ 3rd–4th decade 
 Mostly manifest in adult life 
▫ 10% in childhood 
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Achados em CXR 
• Location 
▫ About 2/3 in lower lobes 
▫ Then, middle lobe 
▫ Then, upper lobes 
• Medial third of lung 
• Often subpleural 
• Bilateral in about 1/2 
▫ Multiple in about 1/3 
• Conventional radiography 
▫ Sharply defined mass (90%) 
▫ Cord-like bands from mass to hilum (feeding artery and draining vein) 
▫ 2/3 single, 1/3 multiple 
▫ Enlarge with advancing age 
▫ Change in size with Valsalva maneuver (decrease) 
▫ Phleboliths (rarely) 
 
Achados em CT 
• Study of choice is contrast-enhanced chest CT 
• Feeding vessel or vessels 
• Rapid enhancement on dynamic CT 
• More sensitive than angiography in picking up 
multiple lesions 
 
Pulmonary AVM. A 3 dimensional rendering of the lower lungs in the axial plane 
demonstrates an arteriovenous malformation (black arrow) with an enlarged feeding 
artery and draining vein (black arrows). The diaphragm is shaded pink. 
Referências 
• BRANT, William E.; HELMS, Clyde A. (Ed.). Fundamentals of 
diagnostic radiology. Lippincott Williams & Wilkins, 2012. 
• COLLINS, Jannette; STERN, Eric J. (Ed.). Chest radiology: the 
essentials. Lippincott Williams & Wilkins, 2008. 
• JUHL, John H.; CRUMMY, Andew B.; KUHLMAN, Janet E. 
Interpretação radiológica. Interpretação radiológica, 2000. 
• PLANNER, Andrew; UTHAPPA, Mangerira C.; MISRA, Rakesh R. 
A–Z of Chest Radiology. Cambridge University Press, 2007. 
• WEBB, Wayne Richard; BRANT, William E.; MAJOR, Nancy 
M.Fundamentals of body CT. Elsevier Health Sciences, 2006. 
• WEBB, W. Richard. Radiologic evaluation of the solitary pulmonary 
nodule.AJR. American journal of roentgenology, v. 154, n. 4, 
p. 701-708, 1990. 
• William Herring. LEARNING RADIOLOGY, 2014