101. A few highlights as concerns the differential diagnosis
within pleural/ pulmonal pathology.

Bild 101

As far as this patient is concerned, there is no clinical treatment. There is no sign of septicemia which lends any evidence of empyema.
The history clarifies the situation :
Bronchial carcinoma as well as pneumectomy on the right side.

What precisely compensates the total volume loss of a lung? Can the individual components, which compensate for this volume loss, weigh in a different fashion?
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Of note is
- the huge shift of the mediastinal to the right
- the vast hyperinflation of the left lung
- only a partially moderate deformity of the right Hemithorax
- within the remaining parietal pleura - only this pleural layer remained - a moderate serothorax.

The individual components, which compensate for the volume loss of a lung, can counter-balance this in different ways : this varies from case to case.  The repair process, which attacks the volume loss with a similar mechanism, returns back again in varying ways to the compensatory possibilities.

102. 40 years old corresprondent for Asia. Peel-thin, very regular wall calcification of a cyst.

Bild 102
What is most conspicuous is the missing contour congruence of the thorax wall. The cyst clearly has nothing whatsoever to do with the pleura. A cause of suspicion towards an Echinokokkus cyst , due to the history, was declared. How may one substantiate th

By means of an Intracutan test as well as complimentary binding reaction.

103. This patient has been suffering for the past two months : illness sensation, dyspnoe and loss of weight. It is only at the very first glance that a similarity  - morphologically-speaking – with empyema exists. The clinical  tests, as well as the normal CRP value , do not address this as a pleural empyema.

Pleuritis carcinomatosa
Also, what morphological discovery is “Empyem -atypical ?” Diagnosis suspicion?
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The strong enhanced pleura is nodular-thickened in at least two areas.  Thereby, a smaller perikardial effusion flowing with the thickening of the perikard leaves.
Urgent suspicion of carcinomatose pleurisy ( and also of carcinomatose perikarditis). Primary not known.

104. New case. The background is a “Hypernephroma.”
The carcinomatose pleurisy leads to no difficulties as concerns diagnosis : mutliple, irregular, knotty, gnarled thickening of the pleura, circumferential thickening ( more than 1 cm) and medistinal involvement. Quite often it is far more difficult. The cause of that particular CT-diagnosis enjoys a high specificity but, in contrast, a rather low sensitivity (Leung).

Pleuritis carcinomatosa, Hypernephroma
Bild 104
What, therefore, could be the possible reason for such a carcinomatose pleurisy?
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Bronchogenic carcinoma, lymphoma, breast carcinoma, metastatic spread arising from abdominal tumours. The precise relative frequency are not known to me.

105. To continue with neoplasms

Bronchogenic tumor
Bild 105

The patient displays a - small, fresh pleural effusion on the right, which has subsided in a supine position towards the dorsal area,- as well as a loculated effusion on the right, aside the ventral side.


But what exactly is the main diagnosis?
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On the right and centrally-located: broncial carcinoma ;
The neoplasm probably grows in the larger veins (that flow towards the left atrium). - Such a tumour can infiltrate the pleura or grow in a metastasic way. The most secure clinical sign for infiltration is pain.