Radiological imaging of pleural diseases.

Dr/ ABD ALLAH NAZEER. MD.

Imaging modalities.Plain X-Ray.Ultrasonography.CT Scan.MRI.

Pleural diseases.. Pleural effusion.. Pneumothorax.. Empyema.. Hydropneumothorax.. Pyopneumothorax.. Hemothorax.. Chylothorax.. Focal pleural lesion.. Malignant mesothelioma.. Metastasis.

Pleural effusion.Definition: An accumulation of pleural fluid in the potential space between parietal and visceral pleura.Pathogenesis:= Increased pleural fluid formation.= Decreased pleural fluid absorption.= Both increased formation and decreased absorption.. Increased pleural fluid formation:-Increased interstitial fluid in the lung.- Increased intra-vascular pressure in pleura.- Increased permeability of the capillaries in the pleura.- Decreased pleural pressure.-Increased fluid in the peritoneal cavity.- Disruption of the thoracic duct.-Disruption of the blood vessel in the thorax.. Decreased pleural fluid absorption:-Obstruction of the lymphatic draining.- Elevation of the systemic vascular pressure.

CT and MRI images of pleural effusion.

Spontaneous Pneumothorax Tension Pneumothorax

Right lung pneumothorax with lung collapse.

Bilateral encysted empyema in an immunocompromised patient

Empyema from lung abscess.

Right-sided hydropneumothorax.

Hydropneumothorax.

Pyopneumothorax.

Right Hemothorax with bullet.

SVC stent and large right Chylothorax.

Focal pleural disease.Focal pleural disease may be divided into localized pleural thickening, pleural calcification, or pleural mass.Localized pleural thickening is usually result from peripheral parenchymal or pleural disease.Pleural calcification is usually result from old inflammatory disease versus asbestosis.Focal pleural masses are usually benign neoplasms such as lipoma and localized fibrous tumour. The benign tumour appears as well defined, spherical or oblong masses.

Pleural thickening. Pleural calcification.

Fibrothorax with pleural thickening and calcification.

Left malignant mesothelioma

Mesothelioma.

Right mesothelioma

Left mesothelioma with effusion.

Deciduoid Pleural Mesothelioma in an Adolescent.

Solitary fibrous tumor of the pleura.

Solitary fibrous tumor of the pleura

Pleural metastases.The pleural metastases are one of the vast majority of malignant lesions of the pleura.EpidemiologyThe adenocarcinoma histological type is the most likely to produce metastasis in the pleura.The most common primaries to result in pleural metastases Metastases include:lung cancer - may account for up to 40% of pleural metastases .breast carcinoma .

may account for ~20% of pleural metastases 2

commonly gives a pleural effusionovarian cancerlymphoma - may account ~ 10% of metastases .gastric carcinomainvasive thymoma

Radiographic featuresAlthough pleural effusion is often the major component of metastatic disease to the pleura, other findings include pleural nodules or extensive pleural thickening similar to that of mesothelioma. Plain film:Pleural metastases itself does not usually give radiological image, so that the chest radiograph usually shows only the images of pleural effusion.CT:The CT is the method of choice for the study of pleural metastasis. CT may show nodules radiographically base hidden by pleural effusion. The pleural metastases usually manifest as nodular or lenticular masses. The soft tissue component is enhanced frequently after administration of intravenous contrast. Other findings seen on CT are enlarged mediastinal lymph nodes, lung nodules, rib lesions or subcutaneous mass.

Pleural metastases from thyroid cancer.

Right pleural metastases.

Malignant pleural thickening - non-Hodgkin lymphoma