IMAGE OF THE WEEK

Prof.S.SUNDAR’S unitDr.G.Rengaraj.PG

CXR

• This xray shows an opacity in the lateral 1/3rd of right lower zone extending up along the lateral costal margin with obliteration of right costophrenic angle

• Patchy opacities in the right lower zone

CT

• CT shows pleural effusion on the right side with pleural thickening with fibrotic changes in rt. Middle & lower lobe

Pleural thickening

• It represents the organised end stage of various active processes such as infective & noninfective inflammation( including asbestos exposure & pneumothorax) and hemothorax

• When generalised and gross, it is termed as fibrothorax

• Fibrothorax may cause significant ventilatory impairment

PLEURAL THICKENING

• Normally no line is visible between the inside of the chest wall and the outer border of the lung.

• In response to inflammation of the pleura & fibrosis, the lung may be separated from the chest wall by a pleural line

• The thickening may be localized or generalized.• If localized, it most commonly involves the inferior

portions of the thoracic cavity

Pleural thickening

• With localized pleural thickening the costophrenic angles are partially or completely obliterated

• In such cases decubitus radiographs or USG are indicated to rule out pleural fluid

• In obese pts, subcostal fat may mimic pleural thickening. But it appears as a symmetric,smooth, soft tissue density that parallels over the chest wall and is of greatest thickness over the apices

• In problem cases, with CT it can be identified external to parietal pleura & internal to ribs

Pleural thickening

• Pleurodesis can be diff. from other conditions by th ABSENCE of the GLIDING SIGN(the gliding sign is said to be present when one can see visceral pleura glide over the parietal pleura on USG)

• The pleural thickening that follows pleural inflammation results almost exclusively from the fibrosis of the visceral pleura

• In contrast, the parietal pleura is thickened following asbestos exposure

Pleural thickening

• Radiologically it gives fixed shadowing of water density

• Viewed en profile, it appears as a band of soft tissue density upto approximately 10-mm thick more or less parallel to the chest wall and with a sharp lung interface

Pleural thickening

• USG- homogenous echogenic layer just inside the chest wall. It is not reliably detected unless it is 1 cm or more thick

• CT – very sensitive at detecting pleural thickening. Assessed on the inside of the ribs, where there should normally be no soft tissue density

• The pleural thickening enhances with contrast

Thank you