1、Pleural disease（胸膜疾病）,Zhou LiuCancer Hospital of Chinese Academy of Medical Sciences, Shenzhen Center,Pleural Disease,Epidemiology（流行病学）: 300/100,000 each yearBasic Imaging FindingsPleural effusion（胸腔积液）Pleural thickening（胸膜增厚）Masses（肿物）Pneumothrorax（气胸）,Classification,Asbestos-related benign Pleura
2、l Thickening（石棉相关的良性胸膜增厚）Non-asbestos related benign Pleural disease（非石棉相关的良性胸膜疾病）Malignant Pleural thickening（恶性胸膜增厚）Pleural fluid (including Empyema) 胸腔积液（包括脓胸）Pneumothorax （气胸）Rare Pleural tumors （罕见胸膜肿瘤）Fibroma（纤维瘤）Lipomas and liposarcomas（脂肪瘤和脂肪肉瘤）,Imaging modalities（成像方式）,X-rayInitial choice U
3、SIdentification of pleural fluid & pleural nodularityGuiding pleural procedureHighly operator dependentPET-CTMalignant pleural disease,CTPleural thickeningPleural effusionPleural massesFatty attenuation or CalcificationMRISoft tissue abnormalities（软组织）Younger patients requiring follow-up,delay of 60
4、-90sContrast pleural phase,Normal appearance（正常表现）,Fig. 2. Normal CT with pleural “intercostal stripe” (Arrow).,Fig. 1. Ultrasound: normal lung with pleural stripe (White Arrow) and “comet tail” artefacts伪影 (outlined by small white arrows).,Asbestos-related benign Pleural Thickening（石棉相关的良性胸膜增厚）,Fig
5、. 3. x-ray showing diffuse thickening (arrow) and blunting of costophrenic angle (Right).,Pleural plaques (parietal in origin) 胸膜斑块（壁层胸膜起源）Diffuse visceral Pleural thickening 弥漫性脏层胸膜增厚,Asbestos-related benign Pleural plaque（石棉相关良性胸膜斑块）,Fig. 4. A: CT image showing pleural plaques and associated inter
6、stitial lines (“hairy plaques”) (Arrows). B: Rounded atelectasis球形肺不张 (arrow)C: Pleural lesions mimicking superimposed nodularity in a case with asbestos-related benign pleural disease.,Fig. 6 Increased subpleural fat tissue in a case with asbestos-related benign pleural disease,Fig. 5 Bilateral ple
7、ural thickening in a case with asbestos-relatedbenign pleural disease.,Non-asbestos related benign Pleural disease（非石棉相关的良性胸膜疾病）,Different Causes and similar imaging appearance（不同病因，相似影像表现）,Prior empyema 脓胸 Paticularly tuberculosis 结核Extensive calcificationVolume lossThickened extra-Pleural fat laye
8、rAssociated parenchymal abnormality,Previous traumatic hemothorax 创伤性血胸Pleural calcificationRib deformityNormal lung parenchyma,Post-talc pleurodesis 滑石粉胸腔固定术后Parietal pleural thickeningHigh attenuation talcVisceral thickening,“Sandwich”,Infectious（感染性）,Traumatic（创伤性）,Post-procedure（手术操作后）,Tuberculo
9、us pleurisy TP结核性胸膜炎,Fig. 7 Circumferential smooth pleural thickening and effusion with mediastinal pleural involvement appearance in a TP case, pleural thickening is less than 1 cm.,Fig. 8 Irregular pleural thickening with pleural rind appearance in a patient caused by pleural tuberculosis.,Empyema
10、（脓胸）,Fig.9 B. Increased subpleural fat tissue in a case with empyemaC. CT showing empyema and “split pleura” sign（胸膜分离征）,C,Fig.10 Empyema with pleural split sign. 50-year-old woman with progressive dyspnea and fever. CT shows collected left pleural effusions with pleural split sign (arrow) (a,c) and
11、 pneumonic infiltrate (b,d). The MRI shows on T2-weighted (T2W) images hypointense bands in the hyperintense pleural fluid (e,f). Pneumonia is more restrictive than the pleural transudate on diffusion-weighted imaging (DWI) (g,h).,Post-talc pleurodesis 滑石粉胸腔固定术后,Fig. 11 A: CT post-talc on left circu
12、mferential nodular pleural thickening involving the mediastinal surface with high density elements (white arrows). B: PET scan demonstrating activity post-talc pleurodesis (black arrow).,“Sandwich”,Malignant Pleural thickening恶性胸膜增厚,Metastatic disease : majority & Primary Pleural malignancy(Mesothel
13、ioma),Common radiological appearance 共性Irregular thickening 1cmNodular opacityPleural effusion: 60%Usually unilateralChest wall invasion and rib destructionMetastasis,Mesothelioma 间皮瘤特性Volume lossCoexisted Calcified and non-calcified Pleural plaquesInterstitial disease or asbestosis: 20%,Prior asbes
14、tos exposure,Malignant Pleural Mesothelioma MPM恶性胸膜间皮瘤,Fig. 12 Circumferential pleural thickening with mediastinal pleural involvement in MPM cases (pleural rind).,Mesothelioma,Inflammatory Pleuritis,Metastasis,Fig. 13 Three CT images showing features of malignant disease: nodular thickening (cross)
15、 and mediastinal involvement (arrow), both in the presence of pleural effusion (E).,Malignant Pleural Thickening恶性胸膜增厚,Fig. 14 (A) A soft tissue mass in a MPD case. (B) A soft-tissue mass with circumferentially pleural involvement in a MPM case.,Malignant Pleural Thickening恶性胸膜增厚,Fig. 15. CT image (
16、A) and PET/CT image (B) highlighting malignant disease (bright red).,Caution False positive：Infection （感染，如肺结核）Post-talc pleurodesis滑石粉胸腔固定术后False negative:Epitheloid Mesothelioma（上皮样间皮瘤）,Pleural fluid (including Empyema)胸腔积液（包括脓胸）,Fig a: Pleural effusion“meniscus sign”,Fig b: Loculated Pleural effu
17、sionCauses: Empyema&HemothoraxAppear in different areassharp medial marigin and hazy lateral margin,Only evident over 200ml500ml might appear normal,Fig. 16 x-ray (A) pleural effusion(B) loculated pleural effusion,Fig. 17 A: US showing pleural effusion (E) with early septations (arrows).“Infected or
18、 malignant effusions”B: US showing organising pleural effusion with heavy mature septations (arrow).“honeycomb-like appearance”,Pleural fluid (including Empyema)胸腔积液（包括脓胸）,Pneumothorax （气胸）,Fig. 18. CXR and CT showing pneumothorax. Arrow demonstrating visible visceral pleural edge.,Fibroma（纤维瘤）,Fig.
19、 19 A: CT showing large pleural fibroma (*) with heterogeneous pattern post-contrast B: MRI (STIR image) showing large pleural fibroma (*).,Homogeneous on unenhanced CTVary in sizeCausing atelectasis in adjacent lungSmooth tapering marginObtuse angle at the junction of the mass and pleuraHeterogeneo
20、us after contrast(40%),Fig.20 Solitary fibrous tumor with nidus sign. A 40-year-old woman with impression of elevated right diaphagm (a,b). A PET-CT (c,d,e) shows a supradiaphragmatic mass, with no obvious FDG avidity (e). The coronal T2-weighted (T2W) with fat saturation confirms the lesion (f), an
21、d diffusion restrictive pattern at b=0 (g) and b=100 suggests the nidus because of central signal loss (arrowhead) (h). The central nidus shows the vascular structure (arrowhead), hypointense on the VIBE sequence after gadolinium IV because of signal void phenomenon (arrow, i and j).,Lipomas and liposarcomas（脂肪瘤和脂肪肉瘤）,Fig. 15. CT with contrast showing pleural lipoma (*). A: Using lung windows; B: Using mediastinal windows (Note low density of lipoma).,Thank you,
