Pleura

Question 1

Enhancing pleural collection

Answer 1

• Empyema - lenticular shaped enhancing, gas filled collection in pleural space; split pleura sign indicates complex collection; subpleural edema
• Abscess - spherical collection
• Hemothorax
• Parapneumonic effusion
• Malignancy (mets; mesothelioma; fibrous tumour of pleura)

Question 2

Nodular pleural thickening

Answer 2

• Mesothelioma - most common 1ry, hx of asbestos exposure and pleural plaques with pulmonary fibrosis = diagnostic
• Mets (adenocarcinomas) - most common malignancy of pleura
• Fibrous tumour of pleura
• Empyema

Question 3

Pleural soft tissue mass

Answer 3

• Fibrous tumour of pleura - asymptomatic, large, heterogenously enhancing pedunculated mass; hypertrophic osteoarthropathy, clubbing, hypoglycemia, galactorrhea
• Mets - adenocarcinoma
• Mesothelioma
• Empyema/abscess - fluid density, homogenous
• Lipoma - homogenous

Question 4

Pleural plaques

Answer 4

• Asbestos exposure - presence of bilat plaques+fibrosis = asbestOSIS
• Prior empyema/trauma - unilateral plaques

Question 5

Persistent PTX

Answer 5

• Chest tube malfunction
• Air leak (bronchopleural fistula)
• Inability to re-expand, i.e.: trapped lung (associated pleural thickening)