Pleural Nodules Research Articles

Clinical analysis of 19 patients with pleural mesothelioma

To summarize the experience in the diagnosis of pleural mesothelioma. Analysing the clinical data of 19 patients with pleural mesothelioma, including age, history of exposure to asbestos, clinical manifestations, imaging and laboratory examinations and metastases. None of the 19 patients had history of exposure to asbestos. Eight cases(42.1%) had no obvious thoracodynia, 9 cases(47.4%) had pleural effusion limited to the right chest, and in 2 cases(10.5%) the brachialis plexus was involved, and in 1 case (5.3%) malignant mesothelial cells were detected in the pleural effusion. Pleural thickening or nodules were found in 13 cases on CT and in 9 cases by B ultrasonographic examination. Exposure to asbestos is not the only cause of pleural mesothelioma. Chest pain is not always associated with pleural mesothelioma. CT and B ultrasonography are of good help in the diagnosis of pleural mesothelioma.

Single pleural nodule in the minor fissure: an unusual manifestation of tuberculosis

Single pleural nodule in the minor fissure: an unusual manifestation of tuberculosis

From the archives of the AFIP. Malignant pleural mesothelioma: radiologic-pathologic correlation.

Malignant pleural mesothelioma (MPM) is a rare malignant neoplasm that typically affects individuals occupationally exposed to asbestos through a variety of industries. The patients experience an insidious onset of symptoms, including dyspnea, chest pain, cough, malaise, and weight loss. The pathologic diagnosis of MPM is difficult, and special stains or immunohistochemical or ultrastructural analysis may be required to differentiate MPM from metastatic adenocarcinoma. The tumor affects both the parietal and visceral pleural surfaces and progresses to encase the lung and invade the lung, mediastinum, and chest wall. Radiologically, MPM manifests as unilateral pleural effusion, pleural nodules, or pleural masses. Imaging studies are useful for diagnosis and staging in patients who are potential surgical candidates. Although a variety of multimodality therapies are available and radical surgical procedures have been developed, the prognosis remains dismal.

Marked Eosinophilia in the Pleural Fluid Associated with Pleural Rheumatoid Nodules

We report a case of a 39-year old African-American man with an eosinophilic (86%) pleural effusion. The finding of rheumatoid nodules in the pleura, with positive assays for rheumatoid factor in both the pleural fluid and blood, suggests rheumatoid disease as the etiology, although the patient did not have any articular manifestations. After the removal of the fluid, no reaccumulation occurred during 6 months of follow-up, and arthritis had not yet appeared.

CT and pathological correlation of pulmonary sarcoidosis

In CT the presence of mediastinal or hilar lymphadenopathies and thickened bronchovascular bundles are landmarks for the diagnosis of pulmonary sarcoidosis. The major CT findings for parenchymal involvement are thickened bronchovascular bundles, large parenchymal nodules, pleural or subpleural nodules, ground-glass opacities, local lung volume loss (distortion of the lung parenchyma), and microscopic and macroscopic honeycombing. The thickened bronchovascular bundles correspond histologically to granulomas, either with or without perigranulomatous fibrosis in the connective tissue sheath around the pulmonary vessels and airways. Conglomerate granulomas are represented on CT by high-attenuation nodules, and the ground-glass opacities are caused by the summation of a number of small granulomas in the interstitium.

A CASE OF MALIGNANT TERATOMA OF THE ANTERIOR MEDIASTINUM PRODUCING ALPHA-FETOPROTEIN-

A case of AFP producing malignant teratoma of the anterior mediastinum which rapidly enlarged is reported. A 30-year-old man was found having an anterior mediastinal tumor on a chest X-ray film on a regular check-up. AFP level that had increased preoperatively to 2221.0ng/ml was normalized postoperatively. Histologically, the tumor was diagnosed as malignant teratoma with yolk sac carcinomatous area, with metastasis to mediastinal lymph nodes. Immunohistochemical staining for AFP was positive in tumor cells. The tumor seemed to have originated from the thymus. The patient postoperatively received two courses of combination chemotherapy with cisplatinum and ectoposide. Fourteen months later, pleural dissemination occurred despite a normal AFP level. After another four courses of combination chemotherapy with cisplatinum, bleomycin and vinblastine, the pleural nodules were reduced in size and number. In a review of the Japanese literature, 18 cases of malignant teratoma with yolk sac tumor were compared with 62 cases of pure yolk sac tumor for AFP level and prognosis.

Pleural dissemination in non‐small cell lung cancer: Results of radiological evaluation and surgical treatment

The aims of this study are to evaluate the diagnostic ability of chest computed tomography (CT) in the early detection of pleural disease and to analyze the results of surgical treatment for lung cancer with pleural dissemination. Twenty-three non-small cell lung cancer patients with pleural dissemination, but without distant metastasis, underwent pleuropulmonary resection during the past 15 years. Chest CT scans were obtained preoperatively in 21 of those patients. In eight patients without pleural effusion, small pleural nodules, about 3-5 mm in size, were found in their chest CT. However, during surgery, small nodules were more frequently observed on the parietal pleura than on the visceral pleura in five of them. Therefore, early detection of the dissemination by chest CT seemed limited to only those of the visceral pleura. In the survival curve after resection, there was no difference among the patients with n2 disease, but there was a significant difference between the patients without n2 disease and those with it (P < 0.05). The presence of n2 disease appeared to be a poor prognostic sign in this form of advanced lung cancer.

Sonographically guided needle biopsy in peripheral thoracic masses: Results in 50 patients

50 patients with thoracic lesions were selected for percutaneous biopsy guided by real-time sonography. The indications were pulmonary, pleural and mediastinal lesions which made contact with the chest wall and sonographically accessible. Included were lesions near vital structures in the mediastinum (n = 3), in the apex of the lung (n = 8), small pulmonary nodules in contact with the chest wall (n = 24), lesions with intervening pleural fluid (n = 2), pleural nodules (n = 9) and masses arising from the chest wall itself (n = 4). A definitive diagnosis was established in 38 of the 45 (84.4%) malignant lesions and in 4 of the 5 (80%) benign lesions. Complications were restricted to one pneumothorax. Sonographically guided biopsy can be carried out as a bedside procedure. Real-time monitoring compensates for respiratory movements. Its role is curbed by intervening air such as in aerated lung, pneumothorax or primarily cavitatory lesions.

Thoracic splenosis after blunt trauma: frequency and imaging findings.

Thoracic splenosis is an uncommon sequela of simultaneous splenic and diaphragmatic injury. The aim of this prospective study was to evaluate the prevalence of thoracic splenosis in 17 subjects who had sustained splenic and diaphragmatic injury and to describe the CT and MR features of thoracic splenosis. All patients had 99mTc-RBC scintigraphy. Subjects with radionuclide uptake in the thorax were further examined with radiography, CT, and MR imaging of the chest. Three subjects (18%) had evidence of ectopic splenic activity in the left side of the thorax. The CT features consisted of one pleural nodule and two pleural masses. The MR appearance of the ectopic splenic tissue was similar to that of normal spleen. Thoracic splenosis occurs with moderate frequency after combined splenic and diaphragmatic injury. The CT appearance is that of pleural masses or nodules. The MR appearance is relatively similar to that of normal spleen.

Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients.

Malignant pleural mesothelioma in rural Turkey frequently results from environmental exposure to tremolite asbestos or fibrous zeolite (erionite). The aim of this study was to determine the CT features of malignant pleural mesothelioma in patients exposed to asbestos or erionite. The CT scans of 84 patients with proved malignant pleural mesothelioma were retrospectively evaluated. Twenty patients (24%) had been exposed to erionite and 64 patients (76%) had been exposed to asbestos. The CT scans were interpreted by seven observers who did not know the clinical or pathologic findings. CT scans showed either unilateral pleural thickening or pleural nodules/masses in all patients. Pleural nodules were present in 25 patients (30%) and pleural masses in 44 patients (52%). Pleural effusion was found in 61 patients (73%), mediastinal pleural involvement in 78 (93%), pleural calcifications in 52 (62%), involvement of the interlobar fissures in 64 (76%), and volume contraction in 61 (73%). Reduced size of the hemithorax was significantly correlated with chest wall involvement. On the basis of CT findings, the preassigned staging was changed in 21 patients (25%), including 44% of the patients with disease that had been classified as stage I. CT findings were not significantly different between the patients exposed to erionite and those exposed to asbestos. The most common CT findings in cases of malignant pleural mesothelioma were unilateral pleural thickening or pleural nodules/masses with or without effusion. CT provided valuable information on the extent of the disease, which was important for staging. Although the CT features are not pathognomonic, they provide valuable clues to the diagnosis in patients who have been exposed to mineral fibers.

Malignant schwannomas of the thorax: CT findings.

We reviewed CT of eight patients with malignant schwannomas arising in the thorax. Only one patient had neurofibromatosis. Five lesions occurred in the posterior mediastinum, one lesion was in the middle mediastinum, and two lesions were in the chest wall. Common CT findings were the presence of low-density areas (six of eight), compression of adjacent structures (six of eight), pleural abnormalities (six of eight), such as pleural effusion or pleural nodules, and metastatic pulmonary nodules (five of eight). Pleural abnormalities or pulmonary nodules were detected in seven of eight patients. These CT findings can help in differentiating malignant schwannoma from benign neurogenic tumor.

Tuberculous pleural effusions: ultrasonic diagnosis.

Twenty patients with tuberculous pleural effusions were studied with ultrasonography. In 18 patients, ultrasonography demonstrated regular pleural thickening which was less than 1 cm except in 1 case. In 4 cases there were a few pleural nodules, whereas in 2 cases the pleural surface showed small nodularity. The latter finding may be diagnostic for a tuberculous etiology. Eighteen patients had multiple, delicate, mobile septations in the effusions, and a lattice-like appearance had formed in 6 cases. Computed tomography was obtained in 7 cases, and pleural thickening was demonstrated in 6 of them. Ultrasonography is a useful imaging modality in the diagnosis of tuberculous pleurisy.

Aggressive treatment of intrathoracic recurrences of thymoma

Between 1974 and 1988, 21 patients with intrathoracic recurrences of thymoma received radiotherapy with radical intent; surgery was always attempted when considered feasible: 11 patients were partially (6 cases) or totally (5 cases) resected before irradiation, while in the other 10 radiotherapy was the only treatment. In 7 cases the recurrence was confined to the anterior mediastinum, 9 had pleural nodules without mediastinal lesions and 5 had both mediastinal and pleural lesions. Mediastinal recurrences were treated by opposed parallel mediastinal fields with 2 3 of the dose delivered through the anterior port: doses ranged between 38 and 44 Gy; a boost of 10–16 Gy was given in patients not radically resected. Pleural nodules were treated with a variety of techniques according to the extent of the lesions. The 7-year survival of the whole group was 70%; 5 patients died: 4 with intrathoracic progression and one with distant metastases. The survival was 74% in the 11 patients having received surgery, either radical or subtotal, and 65% in the 10 patients treated with radiotherapy alone: the difference is not significant. Patients with Kamofsky index >70 had a significantly better survival (100%, versus 28%, p = 0.0015). This is a selected series of patients presenting recurrences still amenable to a radical treatment either by surgery and radiotherapy or by radiotherapy alone: the results confirm that an aggressive approach is warranted in patients in good general conditions with recurrences confined to the mediastinum and/or 1 hemithorax.

Value of sonography in determining the nature of pleural effusion: analysis of 320 cases.

To assess the value of sonography in determining the nature of pleural effusions, we prospectively analyzed the sonographic findings in 320 patients with pleural effusion of various causes (224 with exudates and 96 with transudates). The nature of the effusions was established on the basis of chemical, bacteriologic, and cytologic examination of pleural fluid; pleural biopsy; and clinical follow-up. All patients had high-frequency, real-time sonography performed by one of three sonographers who had no clinical information concerning the patients. The sonographer evaluated the images for internal echogenicity of the effusion, thickness of the pleura, and associated parenchymal lesions of the lung. The images were also printed out and interpreted a second time by the other two sonographers to reach a consensus. Our results showed that the two types of effusions could be distinguished on the basis of sonographic findings. Transudates were anechoic, whereas an anechoic effusion could be either a transudate or an exudate. Pleural effusions with complex septated, complex nonseptated, or homogeneously echogenic patterns were always exudates (p less than .01). Sonographic findings of thickened pleura and associated parenchymal lesions in the lung also were indicative of an exudate (p less than .01). Homogenous echogenic effusions were due to hemorrhagic effusion or empyema. Sonographic evidence of a pleural nodule was a specific finding in patients with a malignant effusion. We conclude that sonography is useful in determining the nature of pleural effusion.

The role of computed tomography (CT) in the investigation of unexplained haemoptysis

Forty patients with a history of haemoptysis, normal chest radiographs apart from evidence of chronic airflow limitation, and normal fibreoptic bronchoscopy (or blood alone in the bronchial tree) were investigated by computed tomography (CT). Abnormalities were seen in 20 (50%) of the CT scans. Seven of the patients had evidence of bronchiectasis (18%), one of whom also had a mass. In four (10%) cases a mass alone was detected (two tuberculous, two malignant). In a further four (10%) scans alveolar consolidation was present and in three cases abnormal vessels were detected (7.5%). One patient had cystic changes shown in their scan and multiple nodules were shown in the final patient. The contralateral lungs of 93 patients undergoing CT for pre-operative assessment of bronchogenic carcinoma were used as controls. In six (6%) of these patients abnormalities were detected by CT. Pleural nodules were observed in two patients, fat in the transverse fissure in another, atelectasis in two patients and an apical bulla in the other abnormal scan. The relative risk for patients with unexplained haemoptysis having abnormal CT scans compared to the control group of patients was 7.75. We conclude that computed tomography is of value in the investigation of patients with unexplained haemoptysis.

Solitary pleural amyloid nodules occurring as coin lesions diagnosed by fine‐needle aspiration biopsy

Solitary pleural amyloid nodule is rare and radiologically can mimic neoplastic lesions. This report describes two cases of this entity diagnosed by fine-needle aspiration biopsy in patients without systemic amyloid deposits. The histologic, ultrastructural, and cytologic features are described.

The role of chest computed tomography in the diagnosis of drug-related reactions

Computed tomography (CT) of the chest provides important information toward the diagnosis of drug-induced lung disease. CT's ability to demonstrate subtle parenchymal and pleural changes, small nodules, and adenopathy is valuable in the early detection of drug-related reactions. CT is also of value in monitoring the appearance, progression, and resolution of pulmonary damage in patients receiving potentially toxic drugs. The CT appearances of specific drug reactions are reviewed, including the spectrum of CT findings in bleomycin toxicity and amiodarone-induced lung disease.

Nocardia infection in patients with liver transplants or chronic liver disease: radiologic findings.

The radiologic findings in eight patients with nocardiosis were reviewed. Infection followed liver transplantation in six cases and was associated with chronic liver disease in two. Abnormalities of the chest radiograph predominated and included pleural effusions (n = 6), consolidation (n = 5), cavitating lesions (n = 1), and intrapulmonary nodules (n = 3), but there were no diagnostic features. The diagnosis was made on the basis of bronchial washings (n = 3), skin aspiration (n = 3), pleural fluid (n = 1), and aspiration biopsy of a pulmonary nodule (n = 1). Computed tomography (CT) was helpful in evaluating chest disease in three cases and allowed guided biopsy to obtain material for a definitive diagnosis. In three patients skin lesions in disseminated disease were associated with cerebral lesions seen at CT. A definitive tissue diagnosis is especially important in patients who have received transplants because of malignancy, since the radiologic manifestations of this unusual infection may mimic metastatic recurrence. Conventional radiography and CT are nonspecific but will enable determination of disease extent and selection of the most suitable site for tissue sampling, which is required to confirm the diagnosis.

EFFECT OF BLOOD TRANSFUSIONS ON EXPERIMENTAL PULMONARY METASTASIS IN MICE

We examined the effect of allogeneic blood transfusions (BT) on pulmonary metastases in a mouse model. Recipient (C57B1/6J) mice were transfused with either saline, syngeneic blood or allogeneic (Balb/c) blood on two occasions, days 0 and 3. One week after the last transfusion, recipient mice were injected intravenously with varying numbers of methylcholanthrene-induced fibrosarcoma cells. Twenty days later the number of pleural nodules was counted as an index of pulmonary metastasis. The data demonstrate that the inoculation of 2.5 x 10(5) or 1 x 10(5) tumor cells resulted in significantly higher numbers of pulmonary metastases in mice that received allogeneic BT than the mice that received syngeneic blood or saline. In contrast, allogeneic BT caused significant inhibition of pulmonary metastases in mice that received 3.5 x 10(5) tumor cells. The data suggest that the immunomodulatory (stimulatory or inhibitory) effect of BT is dependent on the numbers of tumor cells inoculated. It is likely that the conflicting reports in the literature on the effects of BT on tumor growth may be due to inoculation of different numbers of tumor cells. These results have an important bearing in understanding the effect of allogeneic BT on tumor growth both in experimental animals and in cancer patients.

Case of the season: A Vietnamese veteran with multiple pleural nodules

Case of the season: A Vietnamese veteran with multiple pleural nodules