Air in the Pleural Cavity Enhances Detection of Pleural Abnormalities by CT Scan

Chest: The Journal of Circulation, Respiration and Related Systems

Y. C. Gary Lee^1,3¹  Yi Jin Kuok^5²  Rajesh Thomas^1,3³  Edward T.H. Fysh^1,2,3⁴  Claire Tobin^3,4⁵ 

[1] Department of Radiology, Sir Charles Gairdner Hospital, Perth, WA, Australia^5;Department of Respiratory Medicine, Royal Perth Hospital, Perth, WA, Australia^4;Department of Respiratory Medicine, St John of God Midland Hospital, Perth, WA, Australia^2;Pleural Medicine Unit, Institute of Respiratory Health and Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia^1;School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia^3

关键词: biopsy;    indwelling pleural catheter;    malignant pleural effusion;    mesothelioma;    pleural nodule;    pleural thickening;    pleuroscopy;    pneumothorax;    MPE;    malignant pleural effusion;   

DOI  :  10.1016/j.chest.2018.02.038

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Detection of pleural abnormalities on CT scan is critical in diagnosis of pleural disease. CT scan detects minute parenchymal lung nodules, but often fails to detect similar-sized pleural nodularity. This is likely because the density of the visceral/parietal pleura and pleural fluid is similar. We hypothesize that an air-pleural interface enhances detection of pleural abnormalities. We describe six patients with pleural abnormalities that were not (or barely) detected on initial CT scan. However, pneumothorax (either ex vacuo or from a genuine air leak) after pleural fluid drainage permitted the visualization of small pleural abnormalities on CT scan, which would be amenable to imaging-guided biopsies. This case series provides proof-of-principle evidence that the sensitivity of CT scan detection of pleural abnormalities is dependent on adjacent tissue density and can be enhanced by intrapleural air. Future studies of the potential for artificial pneumothorax to improve the diagnosis of pleural disease are warranted.

【 授权许可】

CC BY