Ultrasound evaluation of costochondral abnormalities in children presenting with anterior chest wall mass

Abstract

Objective: The purpose of this article is to summarize our experience with the use of ultrasound for evaluation of costochondral cartilage deformity in patients presenting with an anterior chest wall mass.

Materials and methods: From 2007 to 2012, we identified all patients at our tertiary care children's hospital younger than 18 years old who underwent ultrasound for a clinical indication of anterior chest wall mass of unknown cause. A pediatric radiologist reviewed all ultrasound examinations and other pertinent radiology examinations as well as prior and follow-up clinical history and determined the final clinical cause of the mass.

Results: We identified 16 patients (nine girls and seven boys; age range, 11 months to 16.1 years; mean, 7.5 years). All patients presented with a firm anterior chest wall mass. Three patients had pain. Thirteen patients had prior imaging studies, including chest radiography (n = 13), CT of the chest (n = 1), MRI of the breast (n = 1), and ultrasound of the chest wall (n = 1). In all prior studies the cause of the anterior chest wall mass was missed. Ultrasound showed an angular deformity of a single-level (n = 13) or multilevel (n = 1) costal cartilage, hypertrophy and elongation with mild angulation of the costal cartilage (n = 1), and osteochondroma (n = 1).

Conclusion: Targeted chest ultrasound is a useful diagnostic tool in the evaluation of costochondral cartilage deformities and should be considered in children with a firm anterior chest wall mass and negative radiography.