36. 3D surface reconstruction from the CT: the right side of the chest has been virtually cut off and we are looking into the left chest; inside an extensive, irregular-shaped fibrothorax. There is a distinctive variability in forms (as always in pathological processes).

Pleural calcification in 3D from CT
Bild 36
From which direction are we now looking into the thoracic cavity?
(Click here for the answer)

Left picture: right / slightly ventral.
Right picture: from caudal / right.
What could we do to eliminate the overlay by bones?  
(Click here for the answer)

Perform segmentation, as demonstrated in the next picture.

37. It has no diagnostic importance. In caudal/lateral position the shell is not flat but bulky and raised.

Isolated Pleural calcification
Bild 37
What could this be?
(Click here for the answer)

We can’t diagnose it from these pictures!
But, the final diagnosis is: persistent effusion between both calcified pleural layers; it was diagnosed by ordinary CT-slices and by puncture.

After specific preurisy
Bild 38
Fibrothorax after specific pleurisy. Which signs are clear? What is less distinct? What is new?
(Click here for the answer)

Unusually small amount of shrinkage of the infected thoracic cavity.
Only minimal distortion of the mediastinum to the right (see bifurcation!).
Remarkable  thickening of the ribs on the affected side.
If you remember this sign, you will discover it in the majority of fibrothoraces. It was first described by Eyler and his colleagues.
The duplication of the dorsal pleural calcifications is undoubtedly spectacular. It is a very small persisting effusion between the two (calcified) pleural layers.

Fibrothorax or effusion
Bild 39
Pleural empyema 20 years ago. What is typical? What is particularly strange?
(Click here for the answer)

Here we find almost all of the typical effects of a fibrothorax:
volume-reduced hemithorax,
distortion of the heart / mediastinum,
thickening of the ribs,
intercostal narrowing (excessively),
deformation of the ribs.

The extensive uncalcified layer between pleural calcification and chest wall (marked by the interior contours of ribs) is characteristic.
In the field of radiology, this layer has caused the biggest misunderstanding of the pleura. In the following we will discuss it in detail.
A small hypodense area is surrounded by scar tissue. Could it possibly be a small residual effusion?

40. We find a dense artefact-producing body on the right, in contact with the dorsal rib:
metal splinters.
History of empyema.
There are only a few classical signs of fibrothorax in this case.

Old empyema splinters
Bild 40
Is this, therefore, an unusual phenomenon?
(Click here for the answer)

We see not one but two calcified layers encasing a homogeneous structure. The patient came with the misdiagnosis of simple scarring. – This could only be an effusion and nothing else. We will prove this in the following text by drawing on a significant number of cases.