Al-Hammadi Hospital, Riyadh, Saudi Arabia.

 (Tu Le edited)

Case report:

A 34-year-old,G2P1, from a non-consanguineous couple, was referred to our unit for a large complex cystic mass arising from left chest wall. Her first pregnancy was normal.

Ultrasound findings:

• Well-defined cystic lesion arising from the outer chest wall, low-level echoes noted with positive peripheral vascularity, 12.7 X 6.9  cm in diameter, located from the left median anterior wall extending to posterior median aspect basically at the border of the spinal region. 
• Abnormal right toe.

Other abnormalities could not be excluded due to unfavorable fetal position.

3635 g male neonate was delivered at 37 weeks + 3 days of gestation by Cesaean section due to large chest mass.

Clinical examination:

1) Left chest mass 17X17 cm.
2) Abnormal right toe.

MRI chest before and after contrast injection showed:

A left lateral chest wall soft tissue mass lesion of variable attenuation value with peripheral flicks of calcifications are seen.
Normal lungs and cardiac configuration. Normal pattern of pulmonary vascularity noted bilaterally. Patent tracheo-bronchial tree. Clear both pleural recesses.
Left side chest pectus exacavatum. Normal dorsal spine. Normal CT appearance of the mediastinal great vessels and cardiac chambers. No evidence of mediastinal or paratracheal lymphadenopathy.
Left side lateral chest wall  lesion of variable attenuation values measures 12x8 cm. (Soft tissue hemangioma,  A-V malformation, lymphatic malformation).

Figures 1-6: 35 weeks; well-defined cystic lesion arising from the outer chest wall, low level echoes noted with positive peripheral vascularity.

Figures 7, 8: MRI: 4-chamber view, with chest mass lies anterior & at left side of the chest extending to the mid abdomen

Figures 9, 10: Portable chest x-ray revealed huge left mass; Normal bony texture. No bony defects. No dyschondroplasia; no chondroma; Abnormal arrangement of metatarsal bones of left foot.

Figures 11, 12, 13: Postnatal findings and pathology