Thoracic textilomas: CT findings

Abstract

Objective: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma.

Methods: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus.

Results: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%).

Conclusions: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication.

Figure 1. Intravenous contrast-enhanced chest CT scan with mediastinal window settings. Presence of a bulky cystic mass (arrows) with regular contours and well-defined borders, occupying and bulging the entire lower third of the right hemithorax and crossing the midline. Note peripheral contrast enhancement and typical folds (arrowheads) within the cystic mass, corresponding to the retained surgical sponge.

Figure 2. Non-contrast-enhanced chest CT scan with mediastinal window settings. Presence of an ovoid mass in the lower third of the right hemithorax, with soft tissue density, containing a dense linear image that corresponds to the retained surgical sponge marker (arrows). The lesion has regular contours and maintains, in most of its extent, close contact with the pleural surface.

Figure 3. Axial intravenous contrast-enhanced chest CT scan with mediastinal window settings. Presence of a mass (arrows) with regular contours and welldefined borders at the base of the right hemithorax, compressing the liver and showing a typical spongiform pattern due to the presence of gas within it.

Figure 4. Axial intravenous contrast-enhanced chest CT scan with mediastinal window settings. Presence of a mass with regular contours, well-defined borders, and peripheral contrast enhancement, in close contact with the pleural surface and located posteriorly in the middle third of the left hemithorax.

Figura 1. TC de tórax com janela para o mediastino, com contraste intravenoso. Presença de volumosa massa cística (setas) de contorno regular e limites bem definidos, ocupando e abaulando todo o terço inferior do hemitórax direito e cruzando a linha média. É possível notar o realce periférico pela substância de contraste e o típico pregueado (cabeças de seta) em seu interior, correspondendo à compressa retida.

Figura 2. TC de tórax com janela para o mediastino, sem contraste intravenoso. Presença de massa ovalada no terço inferior do hemitórax direito, com densidade de partes moles, contendo imagem linear densa que corresponde ao marcador (setas) da compressa retida. A lesão tem contorno regular e mantém, em sua maior extensão, íntimo contato com a superfície pleural.

Figura 3. TC de tórax, corte axial, com janela para o mediastino e contraste intravenoso. Presença de massa (setas) com contorno regular e limites bem definidos na base do hemitórax direito, exercendo compressão sobre o fígado e apresentando o típico padrão espongiforme pela presença de gás no seu interior.

Figura 4. TC de tórax, corte axial, com janela para o mediastino e contraste intravenoso. Presença de massa de contorno regular, com limites bem definidos, impregnação periférica pelo meio de contraste, em íntimo contato com a superfície pleural, localizada posteriormente no terço médio do hemitórax esquerdo.