PMC8551644_01
(a): Chest computed tomography showing a small nodular shadow with a tree-in-bud appearance in the left upper lobe.. (b): Chest computed tomography showing encapsulated fluid in the chest wall.
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Six months after thoracoscopy, computed tomography showed that the pleural effusion had decreased in volume, but there were numerous small nodular shadows in the left upper lobe; the nodules had increased in size and showed a tree in bud appearance, and a cystic mass appeared under the left scapula (Fig. 1).
Magnetic resonance imaging and Ultrasonography imaging of chest wall:. (a): An axial T2-weighted image showing a cystic mass with high-signal-intensity fluid deep in the serratus anterior muscle. Arrow head: serratus anterior muscle. Arrow: Latissimus dorsi muscle.. (b): A coronal T2-weighted image showing numerous low-signal-intensity trabecular structures within the cystic mass.. (c): Cystic mass contains hyperechoic deposits.
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Ultrasonography showed that the cystic mass had a wall of approximately 5 mm and contained numerous hyperechoic deposits (Fig. 2). T2-weighted images, suggesting scapulothoracic bursitis (Fig. 2).
Macroscopic findings of the resected specimen:. The dumbbell-shaped cystic mass, measuring 17 x 10 cm, contained serous fluid and numerous coin-shaped fibrin deposits were observed inside.
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The cystic mass was composed of a uniformly fibrous wall containing numerous coin-shaped chondroid bodies (Fig. 3).
Microscopic findings of the cyst wall:. (a): the cyst wall obtained by needle biopsy before antituberculous therapyMultinucleated. giant cells (arrow head) infiltrate the fibrous cyst wall.. (b): Cyst wall of the resected specimen after antitubercular therapy. The cyst wall is infiltrated with inflammatory cells such as lymphocytes, histiocytes, and plasma cells. Granulomatous lesions (arrowheads) with aggregated multinucleated giant cells are observed.
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A granulomatous lesion with clusters of multinucleated giant cells, which was not accompanied by necrosis but suggested tuberculosis infection, was observed (Fig. 4).