Facharzt Radiologie Thorax, Chronisches Empyem (english)

Wolfgang G. H. Schmitt - Buxbaum

Table of Contents

 

 

Abstract:

35 images of pleural calcification dealing in particular with 
Chronic persistent pleural effusions; the latter were observed in 22 out of 140 patients with calcification involving the parietal and visceral pleurae. If no effusion is present, the two adjacent calcified pleurae may adhere together; only one line is typical for a simple pleural scar.

In the presence of fluid the pleural layers are separated, producing more than one linear density on the radiograph. Pleural thickening can exceed 2 cm. A pleural shadow thicker than a finger (about 2 cm) is most likely a residual effusion. The value of CT and sonography in the detection of such persistent effusions is discussed. A rather high density provides no argument against liquid.

Imaging gives no answer on persisting effusions bacteriology. But despite decades of sterility, it can be suddenly infectiously activated without giving a morphological hint. 

In patients with calcified fibrothorax, the calcified parietal pleura is separated from the inner thoracic wall by fat whether an effusion is present or not. 

Chronic persistent pleural effusions show greater number of complications: fistula formation and Empyema necessitatis are  in evidence. 

 

Content: 

41-45: effects of fibrothorax

46-50: drainage, thoracotomy in fibrothorax

51-55: missunderstandings concerning the pleura

56-60: fluoroscopy and CT for diagnosis

61-65: CT and fluroscopy in chronical empyemas

66-70: take home message about the pleura

71-75: long time follow up; fistula, empyema necessitatis