CT appearances of pleural tumours

doi:10.1016/j.crad.2009.03.010

Clinical Radiology

Volume 64, Issue 9, September 2009, Pages 918-930

https://doi.org/10.1016/j.crad.2009.03.010 Get rights and content

Computed tomography (CT) is the imaging technique of choice for characterizing pleural masses with respect to their location, composition, and extent. CT also provides important information regarding invasion of the chest wall and surrounding structures. A spectrum of tumours can affect the pleura of which metastatic adenocarcinoma is the commonest cause of malignant pleural disease, while malignant mesothelioma is the most common primary pleural tumour. Certain CT features help differentiate benign from malignant processes. This pictorial review highlights the salient CT appearances of a range of tumours that may affect the pleura.

Introduction

A variety of tumours can affect the pleura ranging from benign lipoma to rare aggressive malignancies, such as synovial sarcoma. Metastatic adenocarcinoma is the commonest cause of malignant pleural disease, while malignant mesothelioma is the most common primary pleural tumour. Chest radiographs are useful in the initial assessment of suspected pleural disease, but findings may not confidently differentiate benign from malignant conditions. Computed tomography (CT) is the mainstay imaging technique for primary assessment of pleural disease and affords improved sensitivity for identification of a malignant pleural process. Magnetic resonance imaging (MRI) and positron-emission tomography (PET) are complementary techniques for the assessment of pleural disease that can provide additional staging and prognostic information. In this article the spectrum of pleural tumours with particular emphasis on their CT appearances are reviewed.

Section snippets

Pleural anatomy

The lung is surrounded by a smooth membrane of visceral pleura, which invaginates inwards to form the interlobar fissures. The visceral pleura is reflected at the hilum and is contiguous with parietal pleura, which lines the chest wall, lateral aspect of mediastinum, and thoracic surface of the diaphragm.¹ The inferior pulmonary ligament is a reflection of parietal pleura, which extends inferiorly from the hilum to the diaphragm.² The two pleural layers are in close contact and separated by a

CT technique and normal appearances

A contrast medium-enhanced acquisition with 50 s scan delay facilitates optimal visualization of pleural disease.⁵ Some centres advocate an even longer delay of up to 70 s. A single volumetric acquisition, with coverage from thoracic inlet to L3 vertebral body, which marks the inferior extent of the diaphragmatic crus, is recommended and images should ideally be reconstructed with 1 mm or finer section thickness.⁶ This enables multiplanar reformations that encompass the entire diaphragm in the

Benign pleural tumours

Benign pleural tumours are relatively uncommon. The majority are lipomas and solitary fibrous tumours.

Malignant pleural tumours

Metastases are the commonest cause of malignant pleural disease followed by mesothelioma. In addition, a variety of other tumours can arise from the pleural membranes, including lymphoma and sarcomas. Several CT criteria help differentiate benign from malignant pleural disease. Signs that are relatively specific for a diagnosis of malignancy include circumferential pleural thickening, nodular pleural thickening, pleural thickening greater than 1 cm, and involvement of the mediastinal pleural

Conclusion

CT is widely utilized in the investigation of suspected pleural disease and in many cases can reliably distinguish benign from malignant patterns. Relatively specific signs of malignancy include nodular pleural thickening, circumferential pleural thickening, and involvement of the mediastinal pleural surface. CT is particularly useful for guiding pleural biopsy and helps improve diagnostic yield. It also plays an important role in assessing potential resectability and is a valuable means of

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Pictorial ReviewCT appearances of pleural tumours

Introduction

Section snippets

Pleural anatomy

CT technique and normal appearances

Benign pleural tumours

Malignant pleural tumours

Conclusion

Clin Chest Med

Chest

Ann Thorac Surg

Chest

Clin Radiol

Clin Radiol

Chest

Ann Thorac Surg

Clin Radiol

Clin Radiol

Chest

Am J Med

Chest

Lancet

Eur J Radiol

Chest

Clin Oncol

Lancet

Hum Pathol

Anatomy of the pleura

Clin Chest Med

Neoplastic and nonneoplastic conditions of serosal membrane origin: CT findings

RadioGraphics

Physiology and pathophysiology of pleural fluid turnover

Eur Respir J

Anatomy and physiology of the pleural space

Chest Surg Clin N Am

Recommendations for cross-sectional imaging in cancer management

Costal pleura: appearances at high-resolution CT

Radiology

Fat-containing lesions of the chest

RadioGraphics

Imaging of the pleura

Radiology

Localized primary tumors of the pleura: an analysis of 40 cases

Cancer

From the archives of the AFIP: localized fibrous tumor of the pleura

RadioGraphics

Giant malignant fibrous histiocytoma of the pleura arising from solitary fibrous tumour

Thorax

Disseminated malignant solitary fibrous tumor of the pleura

Pathol Int

Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases

Am J Surg Pathol

Spontaneous hypoglycaemia and pleural fibroma—role of insulin like growth factors

Thorax

Solitary fibrous tumor of the pleura

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CT features of solitary fibrous tumour of the pleura: experience in 26 patients

Radiol Med

CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients

AJR Am J Roentgenol

Diagnosis, treatment and long-term outcome of solitary fibrous tumours of the pleura

Eur J Cardiothorac Surg

CT in differential diagnosis of diffuse pleural disease

AJR Am J Roentgenol

Diffuse pleural thickening: percutaneous CT-guided cutting needle biopsy

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The cytologic diagnosis of malignant neoplasms in pleural and peritoneal effusions

Acta Cytol

Thoracic metastases

Thorax

Invasive thymomas: diagnosis and evaluation by computed tomography

J Comput Assist Tomogr

Pleural changes in malignant pleural effusions: appearance on computed tomography

Cleve Clin J Med

Massive pleural effusions: malignant and nonmalignant causes in 46 patients

Am Rev Respir Dis

Thyroid transcription factor 1: a marker for lung adenocarcinoma in body cavity fluids

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Thymoma: radiologic-pathologic correlation

RadioGraphics

Pictorial Review
CT appearances of pleural tumours