Medical History: A 6 months , 6.8 kgs baby came in the opd with chest wall swelling since birth which was earlier central and now increased to right hemithorax . The swelling gradually increased in size and the skin overlying this was red with pain . The baby had on and off cough and cold too. The mother also complained that the body weight did not increase as the baby cannot take food properly due to excruciating pain while feeding.

PET CT: Large lobulated circumscribed expansile soft tissue mass with necrosis, septations & patchy peripheral FDG uptake, is seen likely arising from left 3rd rib postero-laterally, eroding left 4th & 5th ribs, infiltrating left lateral chest wall with significant intrathoracic component, infiltrating upper & lower lobes of left lung, measures ~ 6.3 x 6.0 x 5.6 cm, SUV max 6.1.

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Surgical Procedure: Excision of the mass along with chest wall reconstruction via lateral thoracotomy approach

Technique: After left posterio- lateral thoracotomy via 5th Intercostal space, adhesiolysis done and the mass was identified. Hard mass destroying left 3rd , 4th , 5th ribs with major extension into the thorax compressing left lung. Another external component around 4th rib in parasternal location. Rib defect closed by approximating 2nd and 6th ribs together with Vicryl sutures after placing ICD. Transected Pectoralis muscle repaired with Vicryl 3-0 . Chest wall defect closed with ipsilateral Latissimus Dorsi muscle flap inset with Vicryl 3-0. Skin closed primarily in layers with Vicryl 3-0 and Monocryl 3-0 subcuticular sutures

Biopsy showed : Chondromesenchyma Hamartoma of the chest wall

Postoperative Care: With proper care , the child extubated the next day and discharge from hospital after drain removal on POD 5. The child came for followup after 7 days . the chest xray after surgery and doing good and the child too is playful with no respiratory symptoms and taking food properly as per mother.

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Conclusion: Pediatric chest wall tumours are very rare . Mostly are benigh but they have potential to transform into malignancy. It should never be ignored. We in Narayana Health, Kolkata attend such cases very meticulously with detailed imaging and investigations. Pediatric patient care needs a joint effort from all the departments , so for this case a Multidisciplinnary team was set up comprising the Thoracic Vascular Surgeon, Pediatric surgeon, Plastic surgeon, Pediatric intensivist and the Radiologist for the thorough assesment of the child and treatment options . In detail entire procedure was explained to the parents of the child and the baby underwent the surgery with a curative intent.