Radiological Case: Giant Solitary Fibrous Tumor of the Pleura

Erica Rego; Brian A. Solomon, MD


Appl Radiol. 2018;47(9):41-43. 

In This Article

Imaging Findings

Initial PA and lateral chest X-rays demonstrated apparent elevation of the right hemidiaphragm (Figure 1). A subsequent contrast-enhanced CT scan of the chest demonstrated a heterogeneous, lobulated, hypervascular mass in the right lower hemithorax measuring approximately 18 x 18 x 16 cm (CC, AP, transverse). There was no apparent chest wall or mediastinal invasion and no associated pleural effusion or mediastinal adenopathy was seen. Also, there was no evidence of necrosis or calcification. The mass had a significant systemic arterial supply, primarily from the right inferior phrenic artery. Mass effect resulted in shift of the heart and mediastium to the left (Figures 2). A follow up PET/CT scan demonstrated mild heterogeneous FDG activity within the mass with an SUV of 5.18. No FDG-avid mediastinal or hilar adenopathy was seen and there was no evidence of FDG avid metastasis. Also, there was no evidence of direct chest wall invasion (Figure 3).

Figure 1.

PA chest X-ray demonstrates increased density in the lower right hemithorax that has the appearance of an elevated hemidiagphram.

Figure 2.

Axial (A) and coronal (B) contrast-enhanced CT of the chest demonstrates a large, heterogeneous mass occupying more than 50% of the right hemithorax. It is hyperascular with marked systemic blood supply.

Figure 3.

Coronal PET scan shows mild FDG activity within the mass, but no evidence of distant disease.

Subsequently, the patient underwent a CT-guided transthoracic biopsy followed by complete surgical resection.