Pleuraldisease

（胸膜疾?。㈱houLiuCancerHospitalofChineseAcademyofMedicalSciences,ShenzhenCenterPleuralDiseaseEpidemiology（流行病學）:300/100,000eachyearBasicImagingFindingsPleuraleffusion（胸腔積液）Pleuralthickening（胸膜增厚）Masses（腫物）Pneumothrorax（氣胸）ClassificationAsbestos-relatedbenignPleuralThickening（石棉相關的良性胸膜增厚）Non-asbestosrelatedbenignPleuraldisease（非石棉相關的良性胸膜疾病）MalignantPleuralthickening（惡性胸膜增厚）Pleuralfluid(includingEmpyema)胸腔積液（包括膿胸）Pneumothorax（氣胸）RarePleuraltumors（罕見胸膜腫瘤）Fibroma（纖維瘤）Lipomasandliposarcomas（脂肪瘤和脂肪肉瘤）

Imagingmodalities（成像方式）X-rayInitialchoice

USIdentificationofpleuralfluid&pleuralnodularityGuidingpleuralprocedureHighlyoperatordependentPET-CTMalignantpleuraldiseaseCTPleuralthickeningPleuraleffusionPleuralmassesFattyattenuationorCalcificationMRISofttissueabnormalities（軟組織）Youngerpatientsrequiringfollow-updelayof60-90sContrastpleuralphaseNormalappearance（正常表現）Fig.2.NormalCTwithpleural“intercostalstripe”(Arrow).

Fig.1.Ultrasound:normallungwithpleuralstripe(WhiteArrow)and“comettail”artefacts偽影(outlinedbysmallwhitearrows).Asbestos-relatedbenignPleuralThickening

（石棉相關的良性胸膜增厚）

Fig.3.x-rayshowingdiffusethickening(arrow)andbluntingofcostophrenicangle(Right).Pleuralplaques(parietalinorigin)胸膜斑塊（壁層胸膜起源）DiffusevisceralPleuralthickening彌漫性臟層胸膜增厚Asbestos-relatedbenignPleuralplaque

（石棉相關良性胸膜斑塊）Fig.4.A:CTimageshowingpleuralplaquesandassociatedinterstitiallines(“hairyplaques”)(Arrows).B:Roundedatelectasis球形肺不張(arrow)C:Pleurallesionsmimickingsuperimposednodularityinacasewithasbestos-relatedbenignpleuraldisease.Fig.6Increasedsubpleuralfattissueinacasewithasbestos-relatedbenignpleuraldiseaseFig.5Bilateralpleuralthickeninginacasewithasbestos-related

benignpleuraldisease.Non-asbestosrelatedbenignPleuraldisease

（非石棉相關的良性胸膜疾?。〥ifferentCausesandsimilarimagingappearance（不同病因，相似影像表現）Priorempyema膿胸Paticularlytuberculosis結核ExtensivecalcificationVolumelossThickenedextra-PleuralfatlayerAssociatedparenchymalabnormalityPrevioustraumatichemothorax創(chuàng)傷性血胸PleuralcalcificationRibdeformityNormallungparenchyma

Post-talcpleurodesis滑石粉胸腔固定術后ParietalpleuralthickeningHighattenuationtalcVisceralthickening“Sandwich”Infectious（感染性）Traumatic（創(chuàng)傷性）Post-procedure（手術操作后）TuberculouspleurisyTP

結核性胸膜炎Fig.7CircumferentialsmoothpleuralthickeningandeffusionwithmediastinalpleuralinvolvementappearanceinaTPcase,pleuralthickeningislessthan1cm.Fig.8Irregularpleuralthickeningwithpleuralrindappearanceinapatientcausedbypleuraltuberculosis.Empyema（膿胸）Fig.9B.IncreasedsubpleuralfattissueinacasewithempyemaC.CTshowingempyemaand“splitpleura”sign（胸膜分離征）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

滑石粉胸腔固定術后

Fig.11A:CTpost-talconleftcircumferentialnodularpleuralthickeninginvolvingthemediastinalsurfacewithhighdensityelements(whitearrows).B:PETscandemonstratingactivitypost-talcpleurodesis(blackarrow).“Sandwich”MalignantPleuralthickening

惡性胸膜增厚Metastaticdisease:majority&PrimaryPleuralmalignancy(Mesothelioma)Commonradiologicalappearance共性Irregularthickening＞1cmNodularopacityPleuraleffusion:60%UsuallyunilateralChestwallinvasionandribdestructionMetastasisMesothelioma間皮瘤特性VolumelossCoexistedCalcifiedandnon-calcifiedPleuralplaquesInterstitialdiseaseorasbestosis:20%PriorasbestosexposureMalignantPleuralMesotheliomaMPM

惡性胸膜間皮瘤Fig.12CircumferentialpleuralthickeningwithmediastinalpleuralinvolvementinMPMcases(pleuralrind).MesotheliomaInflammatoryPleuritisMetastasis

Fig.13ThreeCTimagesshowingfeaturesofmalignantdisease:nodularthickening(cross)andmediastinalinvolvement(arrow),bothinthepresenceofpleuraleffusion(E).MalignantPleuralThickening

惡性胸膜增厚Fig.14(A)AsofttissuemassinaMPDcase.(B)Asoft-tissuemasswithcircumferentiallypleuralinvolvementinaMPMcase.MalignantPleuralThickening

惡性胸膜增厚

Fig.15.CTimage(A)andPET/CTimage(B)highlightingmalignantdisease(brightred).CautionFalsepositive：Infection（感染，如肺結核）Post-talcpleurodesis滑石粉胸腔固定術后Falsenegative:EpitheloidMesothelioma（上皮樣間皮瘤）Pleuralfluid(includingEmpyema)

胸腔積液（包括膿胸）Figa:Pleuraleffusion“meniscussign”Figb:LoculatedPleuraleffusionCauses:Empyema&HemothoraxAppearindifferentareassharpmedialmariginandhazylateralmarginOnlyevidentover200ml500mlmightappearnormal

Fig.16x-ray(A)pleuraleffusion(B)loculatedpleuraleffusionFig.17

A:USshowingpleuraleffusion(E)withearlyseptations(arrows).

“Infectedormalignanteffusions”

B:USshowingorganisingpleuraleffusionwithheavymatureseptations(arrow).

“honeycomb-likeappearance”

Pleuralfluid(includingEmpyema)

胸腔積液（包括膿胸）Pneumothorax（氣胸）

Fig.18.CXRandCTshowingpneumothorax.Arrowdemonstratingvisiblevisceralpleuraledge.Fibroma（纖維瘤）

Fig.19A:CTshowinglargepleuralfibroma(*)withheterogeneouspatternpost-contrastB:MRI(STIRimage)showinglargepleuralfibroma(*).HomogeneousonunenhancedCTVaryinsizeCausingatelectasisinadjacentlungSmoothtaperingmarginObtuseangleatthejunctionofthemassandpleuraHeterogeneousaftercontrast(40%)Fig.20Solitaryfibroustumorwithnidussign.A40-year-oldwomanwithimpressionofe