41. Next case. History of left sided pleural empyema; recently a small pneumonia on the right side.
At first glance: mass in the left hilus? Probably bronchial Carcinoma?
- Caution! There is another finding; it is far more serious than a lot of people think: calcification on top of left upper field. What shall we do next?
(Click here for the answer) Years ago the first idea would have been "Fluoroscopy”. Today, however we perform CT. - Contrast-enhanced?
"CT with contrast” answers the question: is it a vascular structure? Is the tissue supplied by blood?
- 42. What do we find in contrast-enhanced CT?
(Click here for the answer) No tumour, but pronounced expansion of the pulmonary artery. The expansion of vascular volume corresponds with the tension of pleuro-pulmonary scars.
We see a pleural scar in the upper field and even a small persistent effusion between the two calcified pleural layers. -
Incidentally, as regards the morphologic findings pulmonary valve function and pressures in the large vessels were normal.
A new accidental finding is a right sited small dorsal pleural effusion, probably related to a recently-experienced case of pneumonia.
43. In the presence of calcified pleura we consider a pleura disease.
In the minority of cases pleura calcification is not a help but a cause for pitfalls.
- What is the mass lesion calcified in the neighbourhood of the pleura ?
(Click here for the answer) A neoplasm; here it’s a peripheral bronchial carcinoma.
The attention was distracted by the pleural finding.
Could the mass be persistent effusion or fibrous tissue?
No, it’s too irregular in shape and too inhomogeneous.
Is another tumour a possibility? Yes, mesothelioma (note the diaphragmal calcification, ask the pulmologist whether there is any suspicion for asbestosis).
44. "H. E.” Old tuberculosis patient. He is ill with acute fever, cough and raised CRP. - Fibrothorax for the last 20 years. You observe signs following fibrothorax.
Bild 44
- What is your diagnosis?
(Click here for the answer) The "Fibrothorax” with calcified inner and outer border produces unusual broad shadowing in the left upper and middle field. Additionally, you can detect streaky shading in the left lower field.
The next picture is part of the CT exam.
45. The irregular shadowing in the left lower lobe is demonstrated in other slices with a positive aerobronchogram. It is not shown here. A pneumonia is most likely together with the clinic.
Bild 45
- How do you describe the lesion in the upper parts of left hemi thorax?
(Click here for the answer) Persisting effusion between both calcified pleurae.