Is the pathology related to the amount of pleural thickening measured by thorax CT?

Abstract

Background: Pathologies associated with pleural thickening are presented along with similar clinical and radiological findings. The present study highlights the importance of the differential diagnosis verification of patients with pleural thickening. Video-assisted thoracoscopic surgery (VATS) is one of the most common diagnostic and therapeutic method used for this purpose. In this study, we aim to deliver our clinical investigation results on patients diagnosed with pleural pathology in the light of recent literature. Methods: During the period of May 2012-June 2014, single port VATS pleural biopsy were successfully performed on 40 patients (25 male and 15 female) in our hospital. Thoracic CT and pathology results were compared. Clinical diagnosis, radiologic findings, and biopsy results were evaluated retrospectively. Results: The average age of the patients is 59.15 ±12.13 (age range 23, 82). There was an environmental exposure to asbestos in 14 patients (35%). 25 patients (62.5 %) was followed with clinical pre-diagnosis of mesothelioma, 8 patients (20%) of tuberculosis, 4 patients (10%) of pleural metastasis and 3 patients (7.5 %) of pleuritis. Histopathologically 8 patients (20%) were diagnosed with malignant mesothelioma, 1 patient (2.5 %) was localized fibrous tumor, 2 patients were (5%) diagnosed with reactive mesothelial hyperplasia, 6 patients (15%) were malignant epithelial tumor metastasis, 16 patients (40%) were fibrinous pleuritis, 6 patients (15%) were chronic granulomatous inflammation, and 1 patient (2.5%) was chronic lymphocytic inflammation. Conclusions: The present study demonstrates insufficency of thoracic CT for diagnosis and differential diagnosis due to similar clinical and radiological findings associated with pathological pleural thickening. Histopathologic examination is required for diagnosis. However, thoracic CT is still a method of radiographic imaging that is actively used in determination of pleural biopsy position, evaluation, and clinical monitoring of response to treatment.