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Surfers’ Knots: An Uncommon Cause of Chest Wall Masses
Nudos de surfistas: una causa poco común de masas en las paredes de la caja torácica
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B) Contrast-enhanced chest CT (mediastinal window). Pulmonary parenchymal consolidation with enhanced thick-walled hypodense collection associated with a 6 cm abscess (necrotizing pneumonia) and pleural effusion. Saccular lesion, measuring 14 mm, associated with mucormycotic pseudoaneurysm. C) Diagnostic-therapeutic arteriography. Saccular lesion associated with pseudoaneurysm in the lower branch of the medial segment of the RLL. D) Pseudoaneurysm appearing smaller than in Figure C, showing contrast extravasation associated with the rupture. E) Embolization by Amplatzer device (black arrow) and placement of coils (yellow arrow) in the arterial branch of the lower medial segment of the RLL. F) Surgical piece after right lower lobectomy, showing necrotic cavity and Amplatzer device (arrow).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AP: anteroposterior; RLL: right lower lobe; Rx: X-ray; CT: computed tomography.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María del Mar García Gallardo, María Lucía Berma Gascón" "autores" => array:2 [ 0 => array:2 [ "nombre" => "María del Mar" "apellidos" => "García Gallardo" ] 1 => array:2 [ "nombre" => "María Lucía" "apellidos" => "Berma Gascón" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621004063?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000001/v1_202201130549/S0300289621004063/v1_202201130549/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Surfers’ Knots: An Uncommon Cause of Chest Wall Masses" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "86" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro Morgan Miguelote, Tatiana Barbassa, Edson Marchiori" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Pedro Morgan" "apellidos" => "Miguelote" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Tatiana" "apellidos" => "Barbassa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Edson" "apellidos" => "Marchiori" "email" => array:1 [ 0 => "edmarchiori@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nudos de surfistas: una causa poco común de masas en las paredes de la caja torácica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1409 "Ancho" => 1667 "Tamanyo" => 250726 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Photograph of the patient's chest, showing a round mass in the right hemithorax, anterior to the lower ribs. (B) T2-weighted magnetic resonance image showing the low signal intensity of the lesions (arrows). Ultrasonography of the lower right (C) and left (D) hemithoraces revealed hypoechoic masses (arrows) with surrounding dermal (black asterisks) and subcutaneous (white asterisks) thickening.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old male surfer presented with the complaint of bilateral palpable masses on the anterior chest wall, which he had first noticed 2 years previously. He had surfed for more than a decade. On physical examination, an elastic mass was palpated on the lower aspect of the right hemithorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Chest magnetic resonance imaging (MRI) showed poorly defined bilateral areas of low signal intensity anterior to the lower ribs on T2-weighted images, more evident on the right side (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). High-frequency (24-MHz) ultrasound in the right-side area revealed a round, ill-defined, hypoechoic mass (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D). Similar, but less prominent, findings were obtained for the left hemithorax. The right-side mass was excised surgically. Microscopic examination revealed dermal thickening with fibroblastoid proliferation and collagen deposition. The final diagnosis was “surfers’ knots”.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">“Surfers’ knots”, or surfers’ nodules, are acquired, benign, fibrotic connective-tissue nodules that develop in response to repetitive friction between the patient's body and the surfboard. Typically affected tibial tuberosities, foot dorsa, and chest.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> Our patient's lower rib cage had suffered intermittent low-grade trauma against the surfboard during paddling. In most cases, the nodules subside or disappear after interruption of the activity. Unusually, the lesions can become infected, painful, and/or permanent, potentially necessitating surgical excision.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> The radiological evaluation allows the diagnosis and it is not necessary, in the appropriate context, to perform more invasive procedures.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest to express.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1409 "Ancho" => 1667 "Tamanyo" => 250726 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Photograph of the patient's chest, showing a round mass in the right hemithorax, anterior to the lower ribs. (B) T2-weighted magnetic resonance image showing the low signal intensity of the lesions (arrows). Ultrasonography of the lower right (C) and left (D) hemithoraces revealed hypoechoic masses (arrows) with surrounding dermal (black asterisks) and subcutaneous (white asterisks) thickening.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The magnetic resonance appearance of surfers’ knots: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.J. McManus" 1 => "A. Thomson" 2 => "A. Whan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.radcr.2016.05.002" "Revista" => array:6 [ "tituloSerie" => "Radiol Case Rep" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "201" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27594950" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surfers’ knots in the anterior chest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Baba" 1 => "Y. Okuyama" 2 => "H. Yakabe" 3 => "S. Yamazoe" 4 => "Y. Kobashi" 5 => "T. Mogami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Case Rep" "fecha" => "2019" "volumen" => "7" "paginaInicial" => "597" "paginaFinal" => "598" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000001/v1_202201130549/S0300289621001216/v1_202201130549/en/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000001/v1_202201130549/S0300289621001216/v1_202201130549/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621001216?idApp=UINPBA00003Z" ]
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