Pleura
Diseases of the pleura and pleural space are common and present a significant contribution to the workload of the chest radiologist. The radiology department plays a crucial role in the imaging and management of pleural disease.
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Pleura Bart Ilsen, Benoît Ghaye, Robert Gosselin, Louke Delrue, Philippe Duyck, and Johan de Mey
Contents
11.5 Empyema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
11.6 Pneumothorax . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 11.6.1 Pneumothorax in the Erect Patient . . . . . . . . . . . . 280 11.6.2 Pneumothorax in the Supine Patient . . . . . . . . . . . 281
11.2 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 11.3 Basic Imaging Principles . . . . . . . . . . . . . . . . . . 270 11.4 Pleural Effusion . . . . . . . . . . . . . . . . . . . . . . . . . 11.4.1 Distribution of Pleural Effusion in the Erect Patient . . . . . . . . . . . . . . . . . . . . . . . . 11.4.2 Distribution of Pleural Effusion in the Supine Patient . . . . . . . . . . . . . . . . . . . . . . . 11.4.3 Atypical Distribution and Loculation of Pleural Fluid . . . . . . . . . . . . . . . . . . . . . . . . . . .
270 271 275 276
11.7 Pleural Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . 281 11.7.1 Focal Pleural Fibrosis . . . . . . . . . . . . . . . . . . . . . . 281 11.7.2 Diffuse Pleural Fibrosis . . . . . . . . . . . . . . . . . . . . 286 11.8 Pleural Neoplasms . . . . . . . . . . . . . . . . . . . . . . . 11.8.1 Localized Pleural Tumors . . . . . . . . . . . . . . . . . . . 11.8.2 Malignant Mesothelioma . . . . . . . . . . . . . . . . . . . 11.8.3 Other Tumors of the Pleura . . . . . . . . . . . . . . . . . . 11.8.4 Pleural Metastases . . . . . . . . . . . . . . . . . . . . . . . .
290 290 290 294 295
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Abstract B. Ilsen (*) Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium e-mail: [email protected] B. Ghaye Department of Medical Imaging, University Hospital of Liege, B35 Sart Tilman, B–4000 Liege, Belgium e-mail: [email protected]
›› Diseases of the pleura and pleural space are
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R. Gosselin, L. Delrue, and P. Duyck Department of Radiology, UZ-Gent, De Pintelaan 185, 9000 Gent, Belgium e-mail: [email protected] e-mail: [email protected] e-mail: [email protected] J. de Mey Department of Radiology, AZ-VUB, Laarbeeklaan 101, 1090 Brussel, Belgium e-mail: [email protected]
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common and present a significant contribution to the workload of the chest radiologist. The radiology department plays a crucial role in the imaging and management of pleural disease. While a number of different imaging modalities may be used, chest radiography remains the first examination in the initial assessment of these patients. Depending on the clinical context, the optimal imaging technique for further evaluation may be computed tomography (CT), ultrasound (US) or magnetic resonance (MR). This chapter reviews chest radiograph findings for some pathologic pleural manifestations by correlating them with their
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