Chest Wall Lump
Assessment & Treatment, London

Most Common — Benign

Lipoma a soft fatty lump

A lipoma is a harmless collection of fatty tissue under the skin. It is the most common cause of a lump anywhere on the body, including the chest wall. Most are superficial — sitting in the layer of fat just under the skin — and feel soft, smooth, and easily moveable when pressed.

A smaller number sit deeper. An intercostal lipoma sits between the layers of muscle between the ribs, and a deep lipoma can extend into the chest cavity itself. These deeper lipomas are usually identified on a CT or MRI rather than on examination, and are removed where they are causing symptoms or where the diagnosis needs to be confirmed. Most superficial lipomas do not need to be removed unless they are growing, painful, or the diagnosis needs confirming.

Common — Benign

Sebaceous Cyst & Rib Prominence

A sebaceous cyst is a blocked skin gland that forms a firm, round sac under the skin, often with a visible central point. Rib prominences — where the rib or the junction between the rib and the cartilage becomes more noticeable than usual — are also entirely benign and often follow weight loss, posture change, or are simply natural variation. Both are identifiable on clinical examination. Removal of a sebaceous cyst is a minor procedure if it becomes infected or bothersome.

Less Common — Benign, May Need Surgery

Schwannoma a nerve-sheath tumour

A schwannoma is a benign tumour that grows from the protective sheath around a nerve. In the chest wall, the nerve is usually one of the intercostal nerves — the nerves that run along the underside of each rib. A schwannoma may present as a firm lump that you can feel between the ribs, or it may be picked up on a scan done for another reason as a smooth, well-defined mass next to a rib. Some cause a focal pain or tingling along the line of the rib.

Most chest wall schwannomas are slow-growing and benign. They are typically removed when they cause persistent pain, when they are growing, or when the diagnosis needs to be confirmed. Removal is usually possible by robotic keyhole surgery — three small incisions, the tumour separated from the nerve where possible, and the patient home within 24–48 hours. Where the nerve cannot be safely preserved, the segment carrying the tumour is removed; the resulting numbness in a strip of skin is usually well tolerated. MRI is the imaging investigation of choice. Dr Okiror performs robotic intercostal schwannoma resection regularly.

Uncommon — Benign, Surgical

Lung Hernia lung pushing through a gap in the chest wall

A lung hernia is where part of the lung pushes through a gap or weakness in the chest wall, sometimes appearing as a soft bulge that becomes visible when you cough, strain, or lift something heavy. It is unusual but not vanishingly rare. There are three main types — spontaneous (typically triggered by a cough, sneeze, or heavy lift in someone with naturally weaker chest wall tissues), traumatic (after a blunt injury or rib fracture), and post-surgical (after a previous chest operation, where the chest wall has not fully healed).

Lung hernias can be picked up on a chest CT scan. A CT performed during a Valsalva manoeuvre — where the patient holds their breath and bears down — sometimes shows a hernia that is invisible on a standard CT.

Repair is a straightforward operation with three parts. First, the lung tissue that has pushed out through the chest wall is gently moved back where it belongs. Second, the gap between the ribs is closed — the ribs are brought back together so the gap is no longer open. Third, the repair is reinforced with a surgical patch, a strong, well-tolerated mesh that supports the chest wall and prevents the hernia from coming back. The result is a durable repair that holds up to coughing, lifting, and normal activity. Most patients stay one or two nights and return to desk work within two to three weeks. Not every lung hernia needs an operation — small hernias that are not painful and not enlarging can be watched.

Uncommon — Benign, Watch or Remove

Osteochondroma a bony outgrowth from the rib

An osteochondroma is a benign bony outgrowth — a knob of bone with a cap of cartilage — that arises from the surface of a rib. It is the most common benign bone tumour anywhere in the body, including the chest wall. Most osteochondromas are picked up on a scan done for another reason and never cause a problem.

The cap of cartilage on the outside of an osteochondroma is the part that needs attention. A cartilage cap of more than two centimetres on imaging warrants surgical removal — not because the lesion is cancer, but because thick cartilage caps have a small but real risk of transforming into a low-grade chondrosarcoma over time. Caps under two centimetres in someone who is well are watched, not operated on. People with hereditary multiple exostoses — a genetic condition where many osteochondromas appear at multiple sites — have a slightly higher lifetime risk and are followed long-term in specialist clinics.

Uncommon — Benign Bone & Soft Tissue

Other Benign Lesions

Fibrous dysplasia — a condition where part of a rib is replaced by fibrous tissue rather than normal bone. It is benign and usually picked up incidentally. Most rib fibrous dysplasia is watched, not operated on. Surgery is considered when the rib is at risk of fracture, when the lesion is causing pain, or when the diagnosis is uncertain.

Chondroma — a benign cartilage tumour arising in a rib or in costal cartilage. The difficulty with chondromas is that they cannot always be reliably distinguished from a low-grade chondrosarcoma without removing them and examining them under the microscope. For this reason, chondromas in the chest wall are usually removed for diagnostic certainty.

Desmoid tumour — a benign but locally aggressive lesion that grows from connective tissue. Desmoids do not spread to other parts of the body but they can grow back if removed without a clear margin. Treatment is decided by a specialist sarcoma multidisciplinary team — sometimes surgery, sometimes a watch-and-wait approach, sometimes systemic medication.

Less Common — Needs Assessment

Soft Tissue Tumour

A soft tissue tumour of the chest wall — which may be benign (such as a desmoid tumour) or, less commonly, malignant (a soft tissue sarcoma) — typically presents as a firm, deepening lump that may be growing. MRI is the investigation of choice. Where a sarcoma is suspected, the case is routed to one of the specialist sarcoma services in London — the Royal Brompton, the Royal National Orthopaedic Hospital, or UCLH — before any surgical decision is made.

Least Common — Specialist Input Required

Primary Rib Tumour

A primary tumour arising from the rib itself — which may be benign (osteochondroma, fibrous dysplasia) or malignant (chondrosarcoma, Ewing sarcoma, plasmacytoma) — presents as a firm, bony swelling. CT and MRI define the extent. Dr Okiror discusses every suspected primary rib tumour with specialist teams at the Royal National Orthopaedic Hospital, Stanmore — the UK’s leading centre for bone tumour management — before any surgical intervention is planned. No patient proceeds to surgery without that specialist input.

Most chest wall lumps are diagnosed by feel: lipomas are soft and moveable, sebaceous cysts have a small visible point on the skin, rib prominences sit on the bone itself, and schwannomas often cause a tender spot along the line of an intercostal nerve. The examination decides what imaging is useful, not the other way round.

Ultrasound is the first imaging step for most lumps where examination has not given a clear answer. It distinguishes a fatty lump (lipoma) from a fluid-filled lump (cyst), and identifies the depth of the lesion. Quick, painless, no radiation.

MRI gives the best soft-tissue detail. It is the investigation of choice for suspected schwannoma, deep lipoma, soft tissue tumour, or any lump where the relationship to a nerve, blood vessel, or muscle layer needs to be defined before surgery.

CT shows bone in detail and is the investigation of choice for any lump that involves the rib itself, for suspected lung hernia (sometimes with a Valsalva manoeuvre), or where a lesion may extend into the chest cavity.

Where a primary bone tumour of the rib is suspected, Dr Okiror discusses every case with specialist teams at the Royal National Orthopaedic Hospital in Stanmore — the UK’s leading centre for bone tumour management — before any surgical intervention is planned. No patient with a suspected rib tumour proceeds to surgery without that specialist team input. Every cancer case is also discussed at the London Bridge Hospital chest MDT, attended fortnightly by Dr Okiror alongside specialist oncologists. Sarcoma cases are routed to the specialist sarcoma services at the Royal Brompton, RNOH, or UCLH.