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MindMap Gallery Diagnostic Imaging Pleural Lesions

Diagnostic Imaging Pleural Lesions

An article about diagnostic imaging: a mind map of pleural lesions, including pleural effusion, pneumothorax and hydropneumothorax, pleural hypertrophy, adhesions and calcifications, pleural masses, etc.

Edited at 2024-03-17 09:22:06

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Diagnostic Imaging Pleural Lesions

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Outline

General Introduction to Medical Imaging Diagnostics
- 30
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Pleural lesions

pleural effusion

X-ray

free pleural effusion

small amount of effusion

When standing, only the posterior costophrenic angle becomes blunt.

The effusion volume reaches 250 mL, and the lateral costophrenic angle becomes blunt and shallow.

It continues to increase, the lateral costophrenic angle disappears, the effusion covers the top of the diaphragm, the outside is high and the inside is low, arc-shaped dense shadow, the lower edge of the front end of the 4th rib on the upper edge

Moderate effusion

The upper limit exceeds the lower edge of the front end of the 4th rib and is below the plane of the lower edge of the front end of the 2nd rib.

The upper edge is curved and concave, and the middle and lower lung fields on the affected side are uniformly dense.

Massive effusion

The upper edge of the curved concave surface exceeds the lower edge of the front end of the 2nd rib

The lung field on the affected side is uniformly dense, the intercostal space is widened, the transverse septum is descended, and the mediastinum is shifted to the healthy side.

localized pleural effusion

encapsulated effusion

Adhesion of the visceral and parietal pleura causes fluid accumulation to be localized in a certain part of the pleural cavity

It is more common in pleurisy, which is more common in the lower chest and posterior chest wall.

Tangent slice: It manifests as a semicircular or mound-shaped uniform dense shadow protruding from the chest wall to the lung field, with clear edges, and the upper and lower edges intersect with the chest wall at an obtuse angle.

interleaf effusion

Fluid accumulation limited to horizontal and oblique fissures

Oblique fissures: interleaf fissures with even spindle shapes and clear edges.

Free effusion enters the interlobular fissure: it is mostly limited to the lower part of the oblique fissure, with the tip of the tip posteriorly and upward as a triangular shadow of increased density (lateral radiograph)

Fluid at the base of the lungs

Fluid is located between the bottom of the lungs and the diaphragm, more common on the right side

The effusion pushes the diaphragm upward, the highest point of the dome is in the outer 1/3, and the costophrenic angle is deep and sharp. (Different from elevated diaphragm)

Small to moderate effusion

Narrow arc-shaped, crescent-shaped liquid density shadow under the posterior chest wall with smooth edges

Fluid moves under the anterior chest wall in the prone position

Massive effusion

There is a fluid-like density shadow in the entire pleural cavity, the lungs are compressed to the hilum and appear as soft tissue shadows, and the mediastinum is shifted to the opposite side.

encapsulated effusion

A convex mirror-shaped liquid density shadow protruding from the chest wall to the lung field, with a wide base and close to the chest wall, an obtuse angle with the chest wall, and smooth edges. There is often thickening of the adjacent pleura, and the pleural tail sign

interleaf effusion

Band-shaped, fusiform, and spherical liquid density shadows in interleaf fissures

The location and course are consistent with the interlobar fissures, liquid-like density, enhanced but not enhanced

Pneumothorax and hydropneumothorax

Rupture of the visceral or parietal pleura allowing air to enter the chest

The simultaneous presence of liquid and gas is called hydropneumothorax

X-ray

No lung texture and gas density in the pneumothorax area

A small amount: Linear or band-like textureless areas, which appear more clearly during exhalation

Large quantities: It occupies the outer zone in the middle of the lung field, and the inner zone is the compressed lung, showing a soft tissue-like shadow of uniform density. The ipsilateral intercostal space is widened, the diaphragm is descended, and the mediastinum is shifted to the healthy side.

Hydropneumothorax: The air-fluid level can be seen on upright chest X-ray. In severe cases, the air-fluid level can traverse the entire chest cavity on the affected side.

Visceral and parietal pleural adhesions may form localized or multilocular pneumothorax or hydropneumothorax

pneumothorax: A band-like extremely low-density area without lung markings on the lateral side of the lung; The medial arc-shaped visceral pleura shows a thin linear soft tissue density shadow, parallel to the chest wall; The lung tissue is compressed to varying degrees, the mediastinum shifts to the opposite side, and the diaphragm descends

Hydropneumothorax: Fluid distribution dorsally, well-defined air-fluid level, collapsed lung margins

Pleural hypertrophy, adhesions and calcification

Cause: Pleuritic fibrinous exudation, granulation tissue hyperplasia, trauma and bleeding organization can be

Pleural hypertrophy and adhesions often coexist

Mild localized pleural hypertrophy and adhesions mostly occur in the costophrenic angle area

Pleural calcification is more common in tuberculous pleurisy, hemorrhagic organizing, and pneumoconiosis

X-ray

Localized pleural hypertrophy and adhesions: the costophrenic angle becomes shallow and flat; Extensive pleural hypertrophy and adhesions, collapse of the thorax on the affected side, narrowing of the intercostal space, increased lung field density, nearly right-angled costophrenic angle, elevated diaphragm, flattening of the top, and mediastinal shift to the affected side

Pleural calcification: flaky, irregular dot-like, and strip-like high-density shadows at the edge of the lung field; Encapsulated pleurisy: calcification is curved and irregular

Pleural hypertrophy: a band-like soft tissue shadow along the chest wall with uneven thickness and uneven surface. Small adhesion shadows are often seen at the interface with the lungs; When the thickness reaches more than 2cm, it is mostly malignant.

Pleural calcification: punctate, band-like, massive high-density shadow, CT value close to bone

Pleural mass

Primary: mostly pleural mesothelioma, rarely connective tissue fibroma, leiomyoma, neurofibroma

Pleural tumors: localized, diffuse (malignant); Masses combined with pleural effusion are mostly malignant

X-ray

Hemispherical, convex mirror-shaped, irregular dense shadow, uniform density, clear edge, intersecting with the chest wall at an obtuse angle

Metastases may cause rib destruction

A mass of soft tissue density connected to the chest wall

The periphery of the mass continues with the pleura to form the pleural tail sign

Enhancement: Many tumors are enhanced