Pleura

Question 1

mesothelioma

Answer 1

aggresive neoplasm of pleura; mostly due to asbestos exposure with latency >20 years

epithelial, sacromatoid, mixed subtypes

Question 2

imaging findings of mesothelioma

Answer 2

nodular concentric pleural thickening, associated pleural effusion and pleural plaques

Question 3

treatment of mesothelioma

Answer 3

extrapleural pneumonectamy, pleurectomy and decortication, trimodality therapy (surgery, intraoperative heated chemotherapy, radiation)

Question 4

pleural mets

Answer 4

lung cancer, GI, GU adenocarcinoma, invasive thymoma

Question 5

multiple myeloma/plasmocytoma and pleura

Answer 5

rib based lesions may appear pleural based

Question 6

fibrous tumor of pleura

Answer 6

focal pleural mass with malignant potential

associated with hypoglycemia and hypertrophic pulmonary osteoarthropathy

low FDG uptake on PET

Question 7

pleural effusion types

Answer 7

transudate, exudate, chylothorax

Question 8

exudate criteria

Answer 8

thoracentesis analysis by Light’s criteria

• ratio of pleural fluid to serum protein >0.5
• ratio of pleural fluid LDH to serum LDH >0.6
• pleural fluid LDH >2/3 upper limts for normal for serum

Question 9

exudate causes

Answer 9

increased permeability of pleural capillaries

pneumonia;parapneumonic effusion (empyema, tb pleuritis), mesothelium or pleural mets, rheumatoid arthritis or collagen vascular diseases

Question 10

chylothorax

Answer 10

effusion of intestinal lymph due to neoplastic obstruction of thoracic duct

seen with lymphangioleiomyomatosis

Question 11

thoracic duct corst

Answer 11

cisterna chyli in upper abdomen, drains into left braciocephalic or subclavian vein