CT AND MR IN PLEURAL DISEASE
Section snippets
CT Findings
On CT, free-flowing pleural fluid produces a sickle-shaped opacity in the most dependent part of the thorax posteriorly (Fig. 1).30 CT allows small amounts of pleural fluid to be detected. Loculated pleural fluid collections are seen as lenticular or rounded opacities in a fixed position (Fig. 2).30 CT is of limited value in differentiating transudates from exudates or in the diagnosis of chylous pleural effusions.30, 40, 42 Acute pleural hemorrhage, however, can be identified either by the
CT
CT is particularly helpful in establishing the diagnosis of empyema and in separating empyemas from lung abscesses. The most reliable sign is the so-called “split-pleura” sign which is usually identified during the organizing phase of an empyema (Fig. 7).52 After intravenous administration of a bolus of contrast medium, the parietal and visceral pleura will enhance vigorously, most likely because of the increased vascular supply in the inflamed pleura.52, 57 In an empyema, the parietal and
PNEUMOTHORAX
The majority of pneumothoraces are accurately demonstrated on standard chest radiographs. Subtle pneumothoraces, however, may not be visible, particularly in patients who are radiographed while supine. These include acutely traumatized patients and intensive care unit patients maintained on ventilator therapy. Such occult pneumothoraces are well shown by CT.56
FOCAL PLEURAL DISEASE
The most common focal pleural abnormalities include pleural plaques, localized pleural tumors, and local extension of bronchogenic carcinoma.
DIFFUSE PLEURAL DISEASE
Both benign and malignant diseases may cause diffuse pleural abnormalities. Causes include benign fibrothorax and malignant tumors such as malignant mesothelioma and metastatic carcinoma.
The radiographic definition of diffuse pleural thickening is somewhat arbitrary, and there is no general consensus on such a definition. It has been suggested, however, that diffuse pleural thickening consists of a smooth uninterrupted pleural opacity extending over at least a fourth of the chest wall with or
References (60)
- et al.
Computed tomographic assessment of patients following radical surgery for malignant mesothelioma
Clin Radiol
(1992) The folded lung
British Journal of Diseases of the Chest
(1966)- et al.
Pleural lipoma: A diagnosis by computed tomography
Chest
(1986) - et al.
Localized fibrous pleural mesothelioma: CT findings
Clin Imaging
(1991) - et al.
Intrapleural fibrinolytic treatment of multiloculated thoracic empyemas
Ann Thorac Surg
(1994) - et al.
The role of computed tomography scanning in the initial assessment and the follow-up of malignant pleural mesothelioma
J Thorac Cardiovasc Surg
(1988) - et al.
Primary malignant localized fibrous tumors of the pleura: Clinical, radiological and pathologic features
Clin Radiol
(1992) - et al.
Pleural tumors and pulmonary tumors: Differential diagnosis
Semin Roentgenol
(1977) - et al.
High resolution CT of benign asbestos-related diseases: Clinical and radiographic correlation
AJR
(1988) - et al.
CT of malignant pleural mesothelioma
AJR
(1981)
CT differentiation of subphrenic abscess and pleural effusion
AJR
Solitary fibrous tumors of the pleura: Eight new cases and review of 360 cases in the literature
Cancer
Atypical transmural thoracic lipoma: CT diagnosis
J Comput Assist Tomogr
MR imaging of pleural effusions
J Comput Assist Tomogr
Computed tomography of localized pleural mesothelioma
AJR
The displaced crus: A sign for distinguishing between pleural fluid and ascites on computed tomography
J Comput Assist Tomogr
Localized benign and malignant fibrous tumors of the pleura: A clinicopathologic review of 223 cases
Am J Surg Pathol
Asbestos-related pleural disease and asbestosis: A comparison of CT and chest radiography
AJR
Computed tomography of benign pleural and pulmonary parenchymal abnormalities related to asbestos exposure
Semin Ultrasound CT MR
Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation
Radiology
Chest-wall invasion by carcinoma of the lung: Detection by MR imaging
AJR
Duodenal hematoma: The ring sign in MR imaging
Radiology
Superior sulcus tumors: CT and MR imaging
Radiology
Pleural effusions: Pathogenesis, radiologic evaluation, and therapy
J Thorac Imaging
Costal pleura: Appearance at high resolution CT
Radiology
Treatment of empyema thoracis (editorial)
Thorax
Malignant pleural mesothelioma. CT manifestations in 50 cases
AJR
Interventional radiology of the chest: Image guided percutaneous drainage of pleural effusions, lung abscess and pneumothorax
AJR
Complex disease of the pleural space: The ten questions most frequently asked of the radiologist - new approaches to their answers with CT and MR imaging
RadioGraphics
CT findings in benign fibrous mesothelioma of the pleura: Pathologic correlation in nine patients
AJR
Cited by (0)
Address reprint requests to Theresa C. McLoud, MD, Department of Radiology - FND 216, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114
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Harvard Medical School, the Department of Radiology and Division of Thoracic and Cardiac Radiology, Massachusetts General Hospital, Boston, Massachusetts