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XRMusculoskeletalConfirmedFRCR 2B
Synovial sarcoma with lung metastases
Clinical Presentation
A 20-year-old male presents with insidious, progressive bone pain waking them from sleep, accompanied by localized palpable swelling and constitutional symptoms.
- 1Soft tissuemasswithin medial suprapatellar pouch with foci of calcification (best seen on lateral)
- 2MRI confirms amassin the medial suprapatellar pouch
- 3It has a heterogenous signal pre-contrast and enhances heterogeneously post-gadolinium
- 4Complete 'white-out' of the left chest with marked mediastinal deviation to the right
- 5Multiple masses in the right lower lobe, better seen on the lateral
- 6From the CXR, it was unclear if the left chest opacity is due to effusion or masses
- 7CT shows huge soft tissue mass occupying the whole of the left chest, causing impressive contra-lateral displacement of the heart
- 8Thick lobulated peripheralpleural thickening, pulmonarymetastasesand pulmonaryatelectasisaccount for the opacity.No significant effusion on this non-contrast scan.Multiple metastases in the right lung.