pleuraldisease胸膜疾病

Pleuraldisease（胸膜疾病）ZhouLiuCancerHospitalofChineseAcademyofMedicalSciences,ShenzhenCenterPleuralDiseaseEpidemiology（流行病学）:300/100,000eachyearBasicImagingFindingsPleuraleffusion（胸腔积液）Pleuralthickening（胸膜增厚）Masses（肿物）Pneumothrorax（气胸）ClassificationAsbestos-relatedbenignPleuralThickening（石棉相关的良性胸膜增厚）Non-asbestosrelatedbenignPleuraldisease（非石棉相关的良性胸膜疾病）MalignantPleuralthickening（恶性胸膜增厚）Pleuralfluid(includingEmpyema)胸腔积液（包括脓胸）Pneumothorax（气胸）RarePleuraltumors（罕见胸膜肿瘤）Fibroma（纤维瘤）Lipomasandliposarcomas（脂肪瘤和脂肪肉瘤）Imagingmodalities（成像方式）X-rayInitialchoiceUSIdentificationofpleuralfluid&pleuralnodularityGuidingpleuralprocedureHighlyoperatordependentPET-CTMalignantpleuraldiseaseCTPleuralthickeningPleuraleffusionPleuralmassesFattyattenuationorCalcificationMRISofttissueabnormalities（软组织）Youngerpatientsrequiringfollow-updelayof60-90sContrastpleuralphaseNormalappearance（正常表现）Fig.2.NormalCTwithpleural“intercostalstripe”(Arrow).Fig.1.Ultrasound:normallungwithpleuralstripe(WhiteArrow)and“comettail”artefacts伪影(outlinedbysmallwhitearrows).Asbestos-relatedbenignPleuralThickening（石棉相关的良性胸膜增厚）Fig.3.x-rayshowingdiffusethickening(arrow)andbluntingofcostophrenicangle(Right).Pleuralplaques(parietalinorigin)胸膜斑块（壁层胸膜起源）DiffusevisceralPleuralthickening弥漫性脏层胸膜增厚Asbestos-relatedbenignPleuralplaque（石棉相关良性胸膜斑块）Fig.4.A:CTimageshowingpleuralplaquesandassociatedinterstitiallines(“hairyplaques”)(Arrows).B:Roundedatelectasis球形肺不张(arrow)C:Pleurallesionsmimickingsuperimposednodularityinacasewithasbestos-relatedbenignpleuraldisease.Fig.6Increasedsubpleuralfattissueinacasewithasbestos-relatedbenignpleuraldiseaseFig.5Bilateralpleuralthickeninginacasewithasbestos-relatedbenignpleuraldisease.Non-asbestosrelatedbenignPleuraldisease（非石棉相关的良性胸膜疾病）DifferentCausesandsimilarimagingappearance（不同病因，相似影像表现）Priorempyema脓胸Paticularlytuberculosis结核ExtensivecalcificationVolumelossThickenedextra-PleuralfatlayerAssociatedparenchymalabnormalityPrevioustraumatichemothorax创伤性血胸PleuralcalcificationRibdeformityNormallungparenchymaPost-talcpleurodesis滑石粉胸腔固定术后ParietalpleuralthickeningHighattenuationtalcVisceralthickening“Sandwich”Infectious（感染性）Traumatic（创伤性）Post-procedure（手术操作后）TuberculouspleurisyTP结核性胸膜炎Fig.7CircumferentialsmoothpleuralthickeningandeffusionwithmediastinalpleuralinvolvementappearanceinaTPcase,pleuralthickeningislessthan1cm.Fig.8Irregularpleuralthickeningwithpleuralrindappearanceinapatientcausedbypleuraltuberculosis.Empyema（脓胸）Fig.9B.IncreasedsubpleuralfattissueinacasewithempyemaC.CTshowingempyemaand“splitpleura”sign（胸膜分离征）CFig.10Empyemawithpleuralsplitsign.50-year-oldwomanwithprogressivedyspneaandfever.CTshowscollectedleftpleuraleffusionswithpleuralsplitsign(arrow)(a,c)andpneumonicinfiltrate(b,d).TheMRIshowsonT2-weighted(T2W)imageshypointensebandsinthehyperintensepleuralfluid(e,f).Pneumoniaismorerestrictivethanthepleuraltransudateondiffusion-weightedimaging(DWI)(g,h).Post-talcpleurodesis滑石粉胸腔固定术后Fig.11A:CTpost-talconleftcircumferentialnodularpleuralthickeninginvolvingthemediastinalsurfacewithhighdensityelements(whitearrows).B:PETscandemonstratingactivitypost-talcpleurodesis(blackarrow).“Sandwich”MalignantPleuralthickening恶性胸膜增厚Metastaticdisease:majority&PrimaryPleuralmalignancy(Mesothelioma)Commonradiologicalappearance共性Irregularthickening＞1cmNodularopacityPleuraleffusion:60%UsuallyunilateralChestwallinvasionandribdestructionMetastasisMesothelioma间皮瘤特性VolumelossCoexistedCalcifiedandnon-calcifiedPleuralplaquesInterstitialdiseaseorasbestosis:20%PriorasbestosexposureMalignantPleuralMesotheliomaMPM恶性胸膜间皮瘤Fig.12CircumferentialpleuralthickeningwithmediastinalpleuralinvolvementinMPMcases(pleuralrind).MesotheliomaInflammatoryPleuritisMetastasisFig.13ThreeCTimagesshowingfeaturesofmalignantdisease:nodularthickening(cross)andmediastinalinvolvement(arrow),bothinthepresenceofpleuraleffusion(E).MalignantPleuralThickening恶性胸膜增厚Fig.14(A)AsofttissuemassinaMPDcase.(B)Asoft-tissuemasswithcircumferentiallypleuralinvolvementinaMPMcase.MalignantPleuralThickening恶性胸膜增厚Fig.15.CTimage(A)andPET/CTimage(B)highlightingmalignantdisease(brightred).CautionFalsepositive：Infection（感染，如肺结核）Post-talcpleurodesis滑石粉胸腔固定术后Falsenegative:EpitheloidMesothelioma（上皮样间皮瘤）Pleuralfluid(includingEmpyema)胸腔积液（包括脓胸）Figa:Pleuraleffusion“meniscussign”Figb:LoculatedPleuraleffusionCauses:Empyema&HemothoraxAppearindifferentareassharpmedialmariginandhazylateralmarginOnlyevidentover200ml500mlmightappearnormalFig.16x-ray(A)pleuraleffusion(B)loculatedpleuraleffusionFig.17A:USshowingpleuraleffusion(E)withearlyseptations(arrows).“Infectedormalignanteffusions”B:USshowingorganisingpleuraleffusionwithheavymatureseptations(arrow).“honeycomb-likeappearance”Pleuralfluid(includingEmpyema)胸腔积液（包括脓胸）Pneumothorax（气胸）Fig.18.CXRandCTshowingpneumothorax.Arrowdemonstratingvisiblevisceralpleuraledge.Fibroma（纤维瘤）Fig.19A:CTshowinglargepleuralfibroma(*)withheterogeneouspatternpost-contrastB:MRI(STIRimage)showinglargepleuralfibroma(*).HomogeneousonunenhancedCTVaryinsizeCausingatelectasisinadjacentlungSmoothtaperingmarginObtuseangleatthejunctionofthemassandpleuraHeterogeneousaftercontrast(40%)Fig.20Solitaryfibroustumorwithnidussign.A40-year-oldwomanwithimpressionofelevatedrightdiaphagm(a,b).APET-CT(c,d,e)showsasupradiaphragmaticmass,withnoobviousFDGavidity(e).ThecoronalT2-weighted(T2W)withfatsaturationconfirmsthelesion(f),anddiffusionrestrictivepatternatb=0(g)andb=100suggeststhenidusbecauseofcentralsignalloss(arrowhead)(h).Thecentralnidusshowsthevascularstructure(arrowhead),hypointenseontheVIBEsequenceaftergadoliniumIVbecauseofsignalvoidphenomenon(arrow,iandj).Lipomasandliposarcomas（脂肪瘤和脂肪肉瘤）Fig.15.CTwithcontrastshowingpleurallipoma(*).A:Usinglungwindows;B:Usingmediastinalwindows(Notelowdensityoflipoma).Thankyou