Mass under sternum?

[clubdeac]

This patient is presenting with a 4 year h/o insidious in onset retrosternal noncardiac chest pain. Can anyone tell me what this is directly under this patient's sternum. Don't mind the air, he had just had a cholecystectomy. The air does however however help to demarcate the mass under the sternum which appears to be just outside the peritoneum. Looks the same on MRI and does not light up with contrast

 

[Lucca]

SDN is not an appropriate place for medical (or diagnostic) advice. Closing thread.

 

[Lucca]

reopening thread, correcting an error on my part in moderation.

 

[maxxor]

This patient is presenting with a 4 year h/o insidious in onset retrosternal noncardiac chest pain. Can anyone tell me what this is directly under this patient's sternum. Don't mind the air, he had just had a cholecystectomy. The air does however however help to demarcate the mass under the sternum which appears to be just outside the peritoneum. Looks the same on MRI and does not light up with contrastView attachment 223172

You need to include more images.

This axial slice is almost fully in the abdomen. At most, the inferior most point of the xiphoid process is visible. Deep to that it looks like fat density with random locules of air. On this single slice, I'd say it's just fat, but more images may make a mass more apparent.

 

[DrfluffyMD]

You need to include more images.

This axial slice is almost fully in the abdomen. At most, the inferior most point of the xiphoid process is visible. Deep to that it looks like fat density with random locules of air. On this single slice, I'd say it's just fat, but more images may make a mass more apparent.

Could also be packing material from surgery.

 

[meister]

"Looks the same on MRI" is not helpful either as there's no such thing as something looking the same on CT and MR, unless you mean it looks like fat on MR.

 

[tco]

Might be a crackhead!

 

[clubdeac]

Yes sorry I'd die load the entire study if I knew how. By the same, I meant it was just read as subcutaneous fat. However the patient is complaining of significant pain. Don't have much to offer other than biopsy

 

[Derv]

Might be a crackhead!

Got hooked on the wrong stuff!

 

[SpartanWolverine]

Got hooked on the wrong stuff!

**who got hold to the wrong stuff (1:00) **

 

[clubdeac]

update: patient seen by thoracic surgery and is being taken in for open excision and biopsy

 

[meister]

Hope it's not a liposarcoma.

 

[clubdeac]

update. below is the path report and 2 week f/u surgeon's note:

"Bony, cartilaginous tissue and skeletal muscle, designated from xiphoid process, excision: Unremarkable bony and cartilaginous tissue with trilineage hematopoiesis"


Patient returns for post op visit s/p xiphoidectomy on 9/15. He did very well
postoperatively, discharging on same day. His pain is markedly improved. He does
still report some msk pain on right posterior thorax, but states this could be
related to posture and activity level being low. He is ready to increase his
activity. Hasn't needed narcotic pain meds. Working normally. Good bowel/bladder
function. No fever, chills, n/v/d/c, chest pain ,sob.

 

[Roberie]

Jesus. I can’t believe that was biopsied.

 

[DeucesHigh3]

This patient is presenting with a 4 year h/o insidious in onset retrosternal noncardiac chest pain. Can anyone tell me what this is directly under this patient's sternum. Don't mind the air, he had just had a cholecystectomy. The air does however however help to demarcate the mass under the sternum which appears to be just outside the peritoneum. Looks the same on MRI and does not light up with contrastView attachment 223172

I for one just like the starry-sky background. How can we get this as an option for our PACS?

 

[tco]

Jesus. I can’t believe that was biopsied.

Not just biopsied. "Open excision and biopsy."

 

[Radology]

It’s normal subxiphoid fat, and there’s air trapped probably along a normal peritoneal attachment/ligament arising from the liver.

Now please tell me where you work so i know never to go there

 

[Cognovi]

How does air get there?

 

[Radology]

How does air get there?

From the cholecystectomy that OP said he just had

 

[Cognovi]

From the cholecystectomy that OP said he just had

Oh goodness. File this under "OSH therapeutic misadventures."