Learning objectives
• Review imaging features of benign and malignant pleural diseases.
• Demonstrate variable imaging findings of pleural neoplasms.
• Illustrate examples of tumor and tumor-like lesions of the pleura.
Background
Introduction
The normal pleura is a thin, barely identifiable soft tissue density lining the inner thoracic cavity on computed tomography (CT) scan. It consists of two layers of serous mesothelial cells with a small amount of pleural fluid in between. The outer parietal layer is attached to the chest wall, and the inner visceral layer covers the lungs, blood vessels, and bronchi.
Although chest radiography is the initial imaging tool for assessment of chest pathology, CT remains the primary modality for the evaluation of pleural...
Findings and procedure details
Approach to pleural tumors or tumor-like lesions
1)Origin of lesion
The first step is to establish the origin of the lesion by assessing the epicenter, angle and definition of borders, and displacement of the pulmonary vasculature and extra-pleural fat.
2)Morphology of lesion
Morphology of the lesion, including size, shape, and borders, can help guide diagnosis. Pleural lesions may be solitary or multiple, focal or diffuse, unilateral or bilateral, and calcified or noncalcified.
3)Benign or malignant features
While there is overlap between the appearances of benign...
Conclusion
Pleural thickening can represent a variety of conditions, both benign and malignant. Once pleural origin is established, assessement of clinical presentation and history, morphology of the lesion, and features of benignity or malignancy help guide diagnosis. Prompt and accurate diagnosis is vitalin guidingmanagement and prognostication.
Personal information and conflict of interest
The authors do not have any financialconflicts of interestto disclose.
References
1. Hussein-Jelen, T., Bankier, A.A., & Eisenberg, R.L.Solid Pleural Lesions. American Journal of Roentgenology, 2012. 198(6), W512–W520.
2. Sureka, B., et al., Radiological review of pleural tumors. The Indian journal of radiology & imaging, 2013. 23(4): p. 313-320.
3. Aluja Jaramillo, F., F. Gutierrez, and S. Bhalla, Pleural tumours and tumour-like lesions. Clin Radiol, 2018. 73(12): p. 1014-1024.
4. Hierholzer, J., et al. MRI and CT in the Differential Diagnosis of Pleural Disease. Chest 2000, 118(3): p. 604–609.
5. De Paoli, L., et al.Imaging characteristics...
