A mass in the chest is an abnormal growth found within the chest cavity. These growths vary in size, location, and composition. Often discovered during medical imaging for other reasons, a professional medical evaluation is important to determine its exact nature.
Understanding Chest Masses
Chest masses are categorized as benign (non-cancerous) or malignant (cancerous). Benign masses do not spread to other parts of the body and often grow slowly, while malignant masses can invade surrounding tissues and metastasize.
These masses can originate from various structures within the chest. They may arise from the chest wall, including bone, cartilage, muscle, or soft tissues. Masses can also develop within the lungs, appearing as nodules or larger growths. Another common area is the mediastinum, the central space between the lungs. This region contains the heart, major blood vessels like the aorta, the esophagus, trachea, thymus gland, thyroid gland, and lymph nodes. Understanding the potential origin helps guide further investigation.
Common Causes of a Chest Mass
A wide range of conditions can lead to the formation of a chest mass, encompassing both non-cancerous and cancerous origins.
Benign Conditions
Cysts, such as bronchogenic cysts present at birth.
Lipomas (fatty tissue tumors) and hemangiomas (abnormal blood vessel growths) in the chest wall.
Enlarged lymph nodes, which may indicate an infection or inflammation within the body, rather than a primary tumor.
Granulomas, small clumps of inflamed cells often resulting from infections like tuberculosis or fungal infections (e.g., histoplasmosis, Valley fever).
Benign tumors like hamartomas and adenomas in the lungs.
Malignant Conditions
Lung cancer, a common cause.
Lymphoma (cancer of the lymphatic system) and thymoma (tumor originating in the thymus gland), frequently found in the mediastinum.
Esophageal cancer.
Metastatic cancer, which has spread from another part of the body (e.g., breast cancer). Approximately 60% of chest wall tumors are cancerous, and metastatic tumors to the chest wall are always considered malignant.
Other Causes
Less common causes include aneurysms, which are bulges in blood vessels like the thoracic aorta, sometimes caused by infections. Infections can also lead to abscesses, which are pus-filled pockets that may appear as masses on imaging. The specific cause of a chest mass necessitates detailed medical investigation to ensure accurate diagnosis and appropriate management.
Recognizing Accompanying Symptoms
Symptoms accompanying a chest mass vary depending on its size, location, and underlying nature. A persistent cough, sometimes with blood, or shortness of breath are common, particularly if the mass affects the lungs or airways. Chest pain or discomfort may also occur. Hoarseness or difficulty swallowing can arise if the mass presses on the vocal cords or esophagus.
Systemic signs like unexplained weight loss, fatigue, or fever may be present, especially with malignant conditions or infections. Swollen lymph nodes in other body areas might also suggest a widespread process. Some chest masses, particularly benign ones, may not cause any symptoms and are discovered incidentally during routine imaging tests, such as a chest X-ray or CT scan. Any new or worsening chest symptoms, or the discovery of an abnormal lump, warrants prompt medical attention for proper evaluation.
Diagnosing a Chest Mass
Diagnosing a chest mass begins with imaging tests to visualize the abnormality.
Imaging Tests
A chest X-ray is often the initial test, revealing a white-grey mass, though it cannot definitively distinguish between cancerous and non-cancerous conditions.
A computed tomography (CT) scan provides more detailed images of bone, soft tissue, and blood vessels, helping to pinpoint the mass’s location, size, and characteristics.
Magnetic resonance imaging (MRI) offers different tissue contrast, assisting in distinguishing between benign and malignant lesions, particularly by highlighting fat or fluid components.
A positron emission tomography (PET) scan can further indicate metabolic activity within the mass, which may suggest the presence of cancer cells.
Biopsy and Other Tests
To establish a definitive diagnosis, a tissue sample is often required through a biopsy.
A needle biopsy, such as a fine-needle aspiration or core-needle biopsy, involves inserting a thin needle through the chest wall to collect cells or a small tissue sample, often guided by CT or ultrasound imaging.
For masses located near the airways, a bronchoscopy with biopsy might be performed, where a flexible tube with a camera is inserted into the lungs to collect samples.
In some cases, a surgical biopsy may be necessary to obtain a larger tissue sample for analysis.
Blood tests can provide supporting information, such as identifying inflammatory markers or certain tumor markers, although they are generally not sufficient for a definitive diagnosis on their own.
General Treatment Approaches
Treatment for a chest mass is highly individualized, depending on the specific diagnosis, including whether it is benign or malignant, its type, size, location, and the patient’s overall health.
For some benign or slow-growing masses not causing symptoms, observation or regular monitoring with imaging tests may be recommended. This approach allows healthcare providers to watch for any changes over time without immediate intervention.
If a mass is caused by infection or inflammation, medication, such as antibiotics or anti-inflammatory drugs, will be the primary treatment. Surgical removal is a common approach, particularly for localized benign masses causing symptoms or for malignant tumors. For malignant masses, radiation therapy (using high-energy rays to destroy cancer cells) or chemotherapy (using powerful drugs to target cancer cells throughout the body) may be employed. These treatments can be used alone, in combination with surgery, or as part of a multidisciplinary approach to manage the disease.