Silikotischer Ballungsherd
Bild 116

116. Silicotic “packed shadow”  in the CT.
The functional impairment can be very minor.

117. Repeat fibrothorax.
The CT of this next patient serves to repeat the findings which we already discussed in the cases from 40 to 75.

Scar right effusion left
Bild 117
What precisely are those findings? What acute occurrence probably took place on the right-hand side?
(Click here for the answer)

- Thick, coarse and calcified fibrothorax on the right-hand side and
- shrinkage of the thorax caverns.
- Thickening of the ribs.
- A partially uncalcified layer between the pleura and the ribs
- however, no distortion of the heart or mediastinum towards the right side.

- On the left side, a fresh pleural effusion, possibly linked to the clearly enlarged heart ( insufficiency on the right side).

To be found : a chronic Empyema on the left side with scarred deformity, bronchiektasis in the shrunken left lung, massive distortion of the heart area and of the mediastinum on the left side, dilatation of the pulmonary arthery under tension of pleural scar.

What acute occurrence most probably took place on the right-hand side?
(Click here for the answer)

Bronchopleural fistula, connection to and with the pleural space; contents of empyema entirly drained via  bronchial system. Thereby, the filling-up of the empty space with air. That is what we found in case 76 too; so we come back to the start of PleuraIII.

I have, honoured and dear readers, posed many questions.
Ask me …………………
what exactly is the “Crux of the Pleura” ?”
One cannot detect the normal pleura.
One can only see it in the pathological sense and then there is not the   professionalism to be able to distinguish between what pleurae are and what may lie in between. That was my main topic, my main theme. In special cases, ( e.g. Calcification) everything is much simpler, provided that, of course, one seizes this unbelievable assistance of Nature itself. Calcification is the large didactic chance for all of us: this is what H.G. Schmitt has formulated. He has battled against the myth ( or is it only a weak and a poor excuse !), namely that the contents of the pleura-caverns are “fibrous tissue”. Such a case was never proved. (The proof and the evidence will at least lend itself to a most clear enhancement of intravenous contrast.)
The MR is rarely necessary : if it is , however, conducted, then it will at least be didactically beneficial.

118. Dear reader, I leaf you alone with some more cases

LightIII empyema fistula
Bild 118
Light III empyema puncture
Bild 119