pleuraldisease胸膜疾病

Pleural disease（胸膜疾病）,Zhou LiuCancer Hospital of Chinese Academy of Medical Sciences, Shenzhen Center,Pleural Disease,Epidemiology（流行病学）: 300/100,000 each yearBasic Imaging FindingsPleural effusion（胸腔积液）Pleural thickening（胸膜增厚）Masses（肿物）Pneumothrorax（气胸）,Classification,Asbestos-related benign Pleural Thickening（石棉相关的良性胸膜增厚）Non-asbestos related benign Pleural disease（非石棉相关的良性胸膜疾病）Malignant Pleural thickening（恶性胸膜增厚）Pleural fluid (including Empyema) 胸腔积液（包括脓胸）Pneumothorax （气胸）Rare Pleural tumors （罕见胸膜肿瘤）Fibroma（纤维瘤）Lipomas and liposarcomas（脂肪瘤和脂肪肉瘤）,Imaging modalities（成像方式）,X-rayInitial choice USIdentification of pleural fluid & pleural nodularityGuiding pleural procedureHighly operator dependentPET-CTMalignant pleural disease,CTPleural thickeningPleural effusionPleural massesFatty attenuation or CalcificationMRISoft tissue abnormalities（软组织）Younger patients requiring follow-up,delay of 60-90sContrast pleural phase,Normal appearance（正常表现）,Fig. 2. Normal CT with pleural “intercostal stripe” (Arrow).,Fig. 1. Ultrasound: normal lung with pleural stripe (White Arrow) and “comet tail” artefacts伪影 (outlined by small white arrows).,Asbestos-related benign Pleural Thickening（石棉相关的良性胸膜增厚）,Fig. 3. x-ray showing diffuse thickening (arrow) and blunting of costophrenic angle (Right).,Pleural plaques (parietal in origin) 胸膜斑块（壁层胸膜起源）Diffuse visceral Pleural thickening 弥漫性脏层胸膜增厚,Asbestos-related benign Pleural plaque（石棉相关良性胸膜斑块）,Fig. 4. A: CT image showing pleural plaques and associated interstitial lines (“hairy plaques”) (Arrows). B: Rounded atelectasis球形肺不张 (arrow)C: Pleural lesions mimicking superimposed nodularity in a case with asbestos-related benign pleural disease.,Fig. 6 Increased subpleural fat tissue in a case with asbestos-related benign pleural disease,Fig. 5 Bilateral pleural thickening in a case with asbestos-relatedbenign pleural disease.,Non-asbestos related benign Pleural disease（非石棉相关的良性胸膜疾病）,Different Causes and similar imaging appearance（不同病因，相似影像表现）,Prior empyema 脓胸 Paticularly tuberculosis 结核Extensive calcificationVolume lossThickened extra-Pleural fat layerAssociated parenchymal abnormality,Previous traumatic hemothorax 创伤性血胸Pleural calcificationRib deformityNormal lung parenchyma,Post-talc pleurodesis 滑石粉胸腔固定术后Parietal pleural thickeningHigh attenuation talcVisceral thickening,“Sandwich”,Infectious（感染性）,Traumatic（创伤性）,Post-procedure（手术操作后）,Tuberculous pleurisy TP结核性胸膜炎,Fig. 7 Circumferential smooth pleural thickening and effusion with mediastinal pleural involvement appearance in a TP case, pleural thickening is less than 1 cm.,Fig. 8 Irregular pleural thickening with pleural rind appearance in a patient caused by pleural tuberculosis.,Empyema（脓胸）,Fig.9 B. Increased subpleural fat tissue in a case with empyemaC. CT showing empyema and “split pleura” sign（胸膜分离征）,C,Fig.10 Empyema with pleural split sign. 50-year-old woman with progressive dyspnea and fever. CT shows collected left pleural effusions with pleural split sign (arrow) (a,c) and pneumonic infiltrate (b,d). The MRI shows on T2-weighted (T2W) images hypointense bands in the hyperintense pleural fluid (e,f). Pneumonia is more restrictive than the pleural transudate on diffusion-weighted imaging (DWI) (g,h).,Post-talc pleurodesis 滑石粉胸腔固定术后,Fig. 11 A: CT post-talc on left circumferential nodular pleural thickening involving the mediastinal surface with high density elements (white arrows). B: PET scan demonstrating activity post-talc pleurodesis (black arrow).,“Sandwich”,Malignant Pleural thickening恶性胸膜增厚,Metastatic disease : majority & Primary Pleural malignancy(Mesothelioma),Common radiological appearance 共性Irregular thickening 1cmNodular opacityPleural effusion: 60%Usually unilateralChest wall invasion and rib destructionMetastasis,Mesothelioma 间皮瘤特性Volume lossCoexisted Calcified and non-calcified Pleural plaquesInterstitial disease or asbestosis: 20%,Prior asbestos exposure,Malignant Pleural Mesothelioma MPM恶性胸膜间皮瘤,Fig. 12 Circumferential pleural thickening with mediastinal pleural involvement in MPM cases (pleural rind).,Mesothelioma,Inflammatory Pleuritis,Metastasis,Fig. 13 Three CT images showing features of malignant disease: nodular thickening (cross) and mediastinal involvement (arrow), both in the presence of pleural effusion (E).,Malignant Pleural Thickening恶性胸膜增厚,Fig. 14 (A) A soft tissue mass in a MPD case. (B) A soft-tissue mass with circumferentially pleural involvement in a MPM case.,Malignant Pleural Thickening恶性胸膜增厚,Fig. 15. CT image (A) and PET/CT image (B) highlighting malignant disease (bright red).,Caution False positive：Infection （感染，如肺结核）Post-talc pleurodesis滑石粉胸腔固定术后False negative:Epitheloid Mesothelioma（上皮样间皮瘤）,Pleural fluid (including Empyema)胸腔积液（包括脓胸）,Fig a: Pleural effusion“meniscus sign”,Fig b: Loculated Pleural effusionCauses: Empyema&HemothoraxAppear in different areassharp medial marigin and hazy lateral margin,Only evident over 200ml500ml might appear normal,Fig. 16 x-ray (A) pleural effusion(B) loculated pleural effusion,Fig. 17 A: US showing pleural effusion (E) with early septations (arrows).“Infected or malignant effusions”B: US showing organising pleural effusion with heavy mature septations (arrow).“honeycomb-like appearance”,Pleural fluid (including Empyema)胸腔积液（包括脓胸）,Pneumothorax （气胸）,Fig. 18. CXR and CT showing pneumothorax. Arrow demonstrating visible visceral pleural edge.,Fibroma（纤维瘤）,Fig. 19 A: CT showing large pleural fibroma (*) with heterogeneous pattern post-contrast B: MRI (STIR image) showing large pleural fibroma (*).,Homogeneous on unenhanced CTVary in sizeCausing atelectasis in adjacent lungSmooth tapering marginObtuse angle at the junction of the mass and pleuraHeterogeneous after contrast(40%),Fig.20 Solitary fibrous tumor with nidus sign. A 40-year-old woman with impression of elevated ri