Malignant pleural effusions

Malignant
solitary fibrous tumor of the pleura slowly growing over 17 years: case report. Serial chest radiographs from 1995 through 2012. (A) The triangular-shaped mass in the right pleural cavity was identified. (B) The mass was stable. (C) The mass exhibited progression in 2006. (D) The mass had grown significantly.
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Pleural
synovial sarcoma. Expiratory chest radiograph demonstrates a moderate to large left pleural effusion with superimposed consolidation, initially interpreted as pneumonia with parapneumonic effusion. There is also a rounded opacity in the left suprahilar region, concerning for mass.
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Pleural
synovial sarcoma. Coronal (A) and axial (b) non-contrasted chest CT images demonstrate a rounded posterior mediastinal mass with associated left pleural effusion and left lower lobe atelectasis.
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Malignant
pleural disease • Pleural malignancy (pleural epithelioid angiosarcoma) - Ganzer Fall bei Radiopaedia
Hacking C, Pleural malignancy (pleural epithelioid angiosarcoma). Case study, Radiopaedia.org (Accessed on 05 Apr 2023) https://doi.org/10.53347/rID-73570 • CC by-nc-sa 3.0 (modified)
Multidetector
CT findings of primary pleural angiosarcoma : a systematic review, an additional cases report. Enhanced multidetector CT (A, B) of a 67-year-old man showed right circumscribed, necrotic pleural masses. PET-CT(C) showed very intense uptake at the right pleural masses. 2D enhanced coronal reformat image (D) showed right visceral (dashed arrows) and parietal pleural masses(arrows)
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Pleuramesotheliom
im Röntgenbild: Zirkuläre Verbreiterung der Pleura links mit Pleuraerguss.
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Multidetector
CT findings of primary pleural angiosarcoma : a systematic review, an additional cases report. Primary pleural angiosarcoma in a 75-year-old man with a history of tuberculosis. Enhanced multidetector CT scan (A, B) showed two, sharply demarcated, biconvex, hypodense masses, arising from chronic tuberculous empyema sequelae with calcific plaques. These masses were directly invaded the extrathoracic regions, resulting in adjacent left 6-8th ribs destruction (B, C). Lung scan (D) CT showed multiple hematogenous metastases in both lung fields, and left rib posterior arc change
cancerimagingjournal.biomedcentral.com • CC-by-4.0
Multidetector
CT findings of primary pleural angiosarcoma : a systematic review, an additional cases report. A 65-year-old man diagnosed with primary pleural angiosarcoma. Enhanced, multidetector chest CT scans showed multiple, small nodules of poorly enhancing nature in the left parietal pleura(asterisk) (A). There were also right large pleural effusion and left small pleural effusion with thin, parietal pleural enhancement (B, C)
cancerimagingjournal.biomedcentral.com • CC-by-4.0
Tumor and
tumorlike conditions of the pleura and juxtapleural region: review of imaging findings. Diagnosis: angiosarcoma. Technique: contrast-enhanced chest CT. Description: A 64-year-old man with no history presented with progressive shortness of breath. The initial contrast-enhanced CT scan (a) to rule out pulmonary embolism shows a well-delineated pleural-based oval lesion (arrow) in the base of the right lung. Findings are relatively aspecific. Follow-up CT examination 4 weeks later (b) shows prominent disease progression, with a large amount of fluid. Despite the relatively short time interval, there is a marked increase in pleural lesions, with widespread focal contrast enhancing pleural lesions in the right hemithorax. The rapid and aggressive progression points to the possible diagnosis of angiosarcoma, which was histologically confirmed
insightsimaging.springeropen.com • CC-by-4.0
Malignant
solitary fibrous tumor of the pleura slowly growing over 17 years: case report. Pre-operative imaging finding. (A) Computed tomography of the chest revealed a large mass in the right pleural cavity, which was inhomogeneous with peripheral enhancement. (B) Positron emission tomography-CT also showed a pleural mass with low metabolic activity (standardized uptake value: 3.17).
cardiothoracicsurgery.biomedcentral.com • CC-by-4.0
Desmoplastic
round cell tumour of pleura with liver and spine metastases: Uncommon pathology with grave prognosis. Coronal reformation demonstrates multiple hypodense lesions in the lower thoracic spine (metastasis) with heterogeneously enhancing nodular thickening on LT side causing collapse of underlying lung parenchyma.
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A case of
malignant solitary fibrous tumour of the mediastinal pleura. Coronal chest CT image shows a well-circumscribed round enhancing solid mass located in the middle part of the mediastinum, with eccentric calcification (arrow).
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A case of
malignant solitary fibrous tumour of the mediastinal pleura. Coronal chest CT image shows a well-circumscribed round mild heterogeneous enhancing solid mass located in the middle part of the mediastinum, with left dislocation of the oesophagus (arrows).
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A case of
malignant solitary fibrous tumour of the mediastinal pleura. Axial chest CT image shows a well-circumscribed round enhancing solid mass located in the middle part of the mediastinum.
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Pleuramesotheliom
rechts: Zirkuläre Verdickung der Pleura. Volumenminderung der rechten Lunge.
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Pleurakarzinose
bei Mamma-Karzinom
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Pleurakarzinose
bei Mamma-Karzinom
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Mesotheliom
der Pleura rechts in der Computertomographie: Mantelförmige Verdickung der Pleura. Ein Pleuraerguss war basal auch vorhanden. Beachte auch die deutliche Volumenminderung der betroffenen Seite.
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Pleural
synovial sarcoma. Coronal (A) and axial (b) non-contrasted chest CT images demonstrate a rounded posterior mediastinal mass with associated left pleural effusion and left lower lobe atelectasis.
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Malignant pleural disease usually heralds a poor prognosis, whether it represents a primary pleural malignancy or metastatic involvement.

Clinical presentation

Clinical presentation is variable. Patients may be asymptomatic or have pleuritic pain. If associated with a sizable pleural effusion, then respiratory compromise may be evident. If a tumor is from the chest wall, then musculoskeletal pain or even a palpable mass may be present.

Pathology

The pleura can be involved by malignancy by three main mechanisms:

  • direct extension from an adjacent tumor, e.g. bronchogenic carcinoma
  • a primary tumor, e.g. mesothelioma, primary pleural lymphoma
  • pleural metastases

    • In each of these, the manifestation can be either solid disease or a malignant pleural effusion, or a combination of both. The relative etiology is :

    Radiographic features

    Conventional imaging is in general highly specific for the diagnosis of pleural malignancy but unfortunately lacks sensitivity .

    Plain radiograph

    Plain films in the setting of malignant pleural effusion are insensitive at distinguishing it from a benign effusion. See malignant vs benign pleural effusion

    In cases where multiple nodular regions or pleural thickening are present the diagnosis may be evident, especially if a primary tumor or other metastatic deposits are visible.

    CT

    CT is the work-horse of pleural imaging, able to achieve specificities of close to 100% . The portal-venous phase (also known as the pleural phase in the chest) is optimal for demonstrating pleural enhancement, rather than arterial phase imaging used routine thoracic CT. A number of features are recognized, including :

    In many cases the primary malignancy will be visible (e.g. breast cancer, bronchogenic cancer) and/or evidence of pulmonary or bony metastases will be visible.

    Nuclear medicine

    FDG-PET is far more sensitive than conventional imaging in diagnosing malignant pleural disease and distinguishing them from benign processes . Hypermetabolism can be seen in either the pleura or pleural effusion. Although both benign and malignant processes, benign processes rarely increase the SUV over 2.0 .

    MRI

    MRI findings of high signal intensity on T2 in relation to intercostal muscles and/or contrast-enhanced on T1 images together with CT morphology has a 100% and a specificity of 93% in the detection of pleural malignancy .

    Treatment and prognosis

    Both treatment and prognosis are dependent on the underlying type of malignancy. In the case of primary malignancies of the pleura (e.g. mesothelioma) resection may be a possibility in highly selected cases.

    Thoracentesis of malignant pleural effusions has limited effect with reaccumulation occurring, on average, at four days.

    In general, and certainly in the case of diffuse pleural metastatic disease, systemic therapies or radiotherapy are the only options. These are discussed separately as part of articles pertaining to individual malignancies:

    Differential diagnosis

    Differential diagnosis depends on the predominant form the pleural disease takes:

    Siehe auch:
    und weiter:
    Assoziationen und Differentialdiagnosen zu maligner Pleuraerguss:
    Pleurakarzinose
     
    Wikipedia • CC BY-SA 4.0
    Pleuraerguss
     
    Wikipedia • CC BY-SA 3.0
    benigne
    pleurale Tumoren
    Wikipedia • CC BY-SA 3.0
    pleurale
    Tuberkulose
    Wikipedia • CC BY-SA 3.0
    Pleuramesotheliom
     
    Wikipedia • CC BY-SA 3.0
    einzelne
    Pleuraraumforderung
    Wikipedia • CC BY-SA 4.0
    Tumoren der
    Pleura
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