In a study of 23 patients who had a chest CT that showed findings suspicious for chest wall invasion by intrathoracic tumors or lung invasion by chest wall tumors, the sensitivity and specificity for chest wall invasion (using absence of a sliding pleura sign) were 88.9% and 100%, respectively, with 100% and 93.3% positive and negative predictive values, respectively [43]. Surgeon-performed US outperformed CT in diagnosis of chest wall invasion, with 90.9% sensitivity and 85.7% specificity versus 61.5% sensitivity and 84.6% specificity for CT [44]. Respective positive and negative predictive values in the same study of 28 patients were 83.3% and 92.3% for US compared with 80% and 68.8% for CT [44]. Another study showed US to have a higher sensitivity than CT for determining chest wall invasion by lung cancer (89% versus 42%, respectively) but had a lower specificity (95% versus 100%, respectively) [45]. However, a study of 131 patients with thoracic masses showed overlap in performance of US and CT for diagnosing chest wall invasion [46]. US may be helpful for image-guided biopsy of superficial lesions [27,32,39,46]. WBC Scan Chest There is no relevant literature to support the use of nuclear medicine WBC scans as initial imaging in the evaluation of chest wall pain in patients with known or suspected malignancy. Variant 3: Nontraumatic chest wall pain. Suspected infectious or inflammatory condition. Secondary evaluation after normal chest radiograph. Next imaging study. Bone Scan Whole Body Nuclear medicine studies, including bone scans and radiolabeled WBC scans, are especially helpful in localization of infectious or inflammatory conditions of the bones, joints, and costal cartilages, especially in the setting of negative radiographs and CT and in patients with metallic implants [47,48]. Bone scintigraphy is useful in screening the entire body for occult infectious or inflammatory disease, especially for patients with fever of unknown origin [26]. Nontraumatic Chest Wall Pain
Nontraumatic Chest Wall Pain. In a study of 23 patients who had a chest CT that showed findings suspicious for chest wall invasion by intrathoracic tumors or lung invasion by chest wall tumors, the sensitivity and specificity for chest wall invasion (using absence of a sliding pleura sign) were 88.9% and 100%, respectively, with 100% and 93.3% positive and negative predictive values, respectively [43]. Surgeon-performed US outperformed CT in diagnosis of chest wall invasion, with 90.9% sensitivity and 85.7% specificity versus 61.5% sensitivity and 84.6% specificity for CT [44]. Respective positive and negative predictive values in the same study of 28 patients were 83.3% and 92.3% for US compared with 80% and 68.8% for CT [44]. Another study showed US to have a higher sensitivity than CT for determining chest wall invasion by lung cancer (89% versus 42%, respectively) but had a lower specificity (95% versus 100%, respectively) [45]. However, a study of 131 patients with thoracic masses showed overlap in performance of US and CT for diagnosing chest wall invasion [46]. US may be helpful for image-guided biopsy of superficial lesions [27,32,39,46]. WBC Scan Chest There is no relevant literature to support the use of nuclear medicine WBC scans as initial imaging in the evaluation of chest wall pain in patients with known or suspected malignancy. Variant 3: Nontraumatic chest wall pain. Suspected infectious or inflammatory condition. Secondary evaluation after normal chest radiograph. Next imaging study. Bone Scan Whole Body Nuclear medicine studies, including bone scans and radiolabeled WBC scans, are especially helpful in localization of infectious or inflammatory conditions of the bones, joints, and costal cartilages, especially in the setting of negative radiographs and CT and in patients with metallic implants [47,48]. Bone scintigraphy is useful in screening the entire body for occult infectious or inflammatory disease, especially for patients with fever of unknown origin [26]. Nontraumatic Chest Wall Pain