Chest Wall Diseases and Tumors

Diseases and tumors in the chest wall are not common, but WakeMed thoracic surgeons offer experience and expertise in the best surgical approaches to these conditions, including minimally invasive options when available.

Our surgeons work in collaboration with other physicians, nurses, radiologists and rehabilitation specialists to provide the most accurate diagnosis and develop a personalized treatment plan for each patient.

Types and Causes of Chest Wall Diseases

Thoracic surgeons at WakeMed treat a variety of chest wall problems, including:

• Thoracic outlet syndrome (TOS): This syndrome can affect nerves, veins or arteries that run through the ring formed by the top ribs, just below the collarbone. TOS occurs when nerves or blood vessels are compressed by a rib, collarbone or muscle, and it can cause pain, numbness or dysfunction in the arm or shoulder on the affected side. Having a cervical rib — an extra rib extending from the neck — increases a person’s risk of developing thoracic outlet syndrome.
• Chest wall malformations: Pectus excavatum and pectus carinatum are congenital conditions that affect the shape of the sternum (breastbone). Pectus excavatum causes the center of the sternum to be sunken inward; pectus carinatum causes the sternum to protrude outward. These conditions can sometimes affect lung and heart function, and they also can have a significant psychological impact.
• Chest wall cancers are rare tumors that develop in the bones, soft tissues or cartilage of the chest cavity. These tumors often have metastasized from other tumors in the thoracic cavity, and they are malignant in more than half of cases. The most common chest wall cancer is sarcoma of the chest wall, including:
  • Chondrosarcoma
  • Ewing’s sarcoma
  • Fibrosarcoma and malignant fibrous histiocytoma
  • Leiomyosarcoma
  • Osteosarcoma
  • Plasmacytoma Other chest wall cancers include metastatic cancer, desmoid tumors and neurogenic tumors.

Symptoms of Chest Wall Diseases

Symptoms of chest wall diseases vary depending on the condition:

• Thoracic outlet syndrome symptoms include pain, tingling or weakness in the shoulder and arm, especially when raising the arms.
• Chest wall malformations may have no symptoms other than an unusual appearance of the chest. Some people with pectus excavatum may experience:
  • Chest pain
  • Decreased tolerance for exercise
  • Fast heart rate (tachycardia)
  • Fatigue
  • Shortness of breath
• Chest wall cancers sometimes have no symptoms. People who experience symptoms usually have one or more of the following:
  • A mass or lump protruding from the chest
  • Chest pain
  • Impaired movement
  • Muscle atrophy
  • Swelling in the chest

Diagnosing Chest Wall Diseases

Our thoracic experts diagnose chest wall diseases using a full spectrum of imaging studies and other tests, depending on what condition is suspected.

Diagnosis of thoracic outlet syndrome includes most or all of the following:

• Physical exam, including maneuvers to provoke symptoms
• Ruling out nerve-related conditions, such as carpal tunnel syndrome, cubital tunnel syndrome, cervical spine disease or other types of nerve entrapment
• Ultrasound to check for narrowing or blockage of blood vessels
• Chest X-ray to check for cervical rib or abnormal first rib
• Brachial plexus block – nerve-related TOS symptoms usually disappear when the scalene muscles of the neck are numbed

Pectus excavatum and pectus carinatum can usually be diagnosed by a physical exam of the chest. Other tests may be performed to check for associated problems with the heart and lungs, including imaging studies, electrocardiogram, echocardiogram, lung function tests and exercise tests.

To diagnose chest wall cancer, our specialists will carefully review your medical history and conduct a full physical examination. Diagnostic testing may include:

• Biopsy
• Bone density test
• Imaging studies such as chest X-ray, computerized tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan and ultrasound.

Treating Chest Wall Diseases

Different types of thoracic outlet syndrome call for different treatments. Treatments may include physical therapy, injections or surgery to cut muscle or remove an extra rib that is pressing on the nerves or blood vessels.

Chest wall malformations may not require any treatment. When the function of the heart or lungs is compromised, the patient’s breathing or posture is affected, or the malformation causes significant emotional distress, surgical treatments may be recommended, including:

• Highly modified Ravtich technique for pectus excavatum, which removes cartilage and elevates the breastbone with two stainless steel struts inserted through a small vertical incision in the mid-chest
• Nuss procedure, a type of VATS (video-assisted thoracic surgery) generally used for adolescent patients with pectus excavatum, in which a curved steel bar (known as the Lorenz Pectus Bar) is inserted through two small incisions under the sternum. It pushes out the depression and is then fixed to the ribs on either side.
• Ostomy procedure for pectus carinatum, in which small bone cuts in the breastbone smooth out the contour and resolve rotation of the bone

Chest wall cancer: These rare cancers are often difficult to treat, and surgery is often necessary. Chest wall resection and reconstruction is the primary surgical option for chest wall tumors. This surgery involves the removal of one or more ribs to extract the tumor, followed by reconstruction to recreate a normal appearance.

Surgery for chest wall cancer is typically used in conjunction with a combination of other treatments, including chemotherapy and radiation therapy. When possible, our surgeons use video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a small camera and surgical instruments into small incisions in the chest to remove the tumor.

Make an Appointment

We welcome new patients. If you’d like to meet with one of WakeMed’s thoracic experts, please make an appointment by calling us at 919-231-6333.