CT findings in Differential Diagnosis between Tuberculous Pleurisy and Malignant Effusion

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1 CT findings in Differential Diagnosis between Tuberculous Pleurisy and Malignant Effusion Poster No.: E-0084 Congress: ESTI 2012 Type: Scientific Exhibit Authors: S. S. Shim, Y. Kim; Seoul/KR Keywords: Thorax, CT, Contrast agent-intravenous, Infection Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Objectives The aim of this study is to describe the computed tomography (CT) features of tuberculous pleurisy and to retrospectively compare the image findings of pleura of tuberculous pleurisy and malignant effusion observed at chest CT. Materials and Methods From 2006 to March. 2011, a total of 135 patients with chest CT scan diagnosed as tuberculous (TB) pleurisy and 69 patients with chest CT diagnosed as malignant effusion were included. Two radiologists (unaware of the pathologic results) evaluated together in random order the CT of 204 consecutive patients. CT scans were assessed in terms of the presence of pleural effusion; presence, extent, location and contour of pleural thickening as suggested by previous studies. Pleural or fissural nodules were analyzed for number, size, and location. The CT findings obtained were compared between TB pleurisy and malignant effusion. Differences in chest CT findings of two diseases were analyzed by using the chi-square test. Results The CT findings of TB pleurisy were effusion without pleural thickening (n=76, 56%), circumferential pleural thickening (n=47, 35%) and nodular thickening (n=12, 9%). 3 cases (2%) of TB pleurisy had circumferential pleural thickening greater than 1cm. The CT features in a malignant effusion were nodular pleural thickening (48%), circumferential thickening (22%), effusion without pleural thickening (28%) and others (2%). In comparison with TB pleurisy and pleural metastasis, the CT finding most suggestive of a malignant cause was nodular pleural thickening (p=0.00). The other findings in terms of circumferential thickening, parietal pleural thickening greater than 1cm and mediastinal pleural involvement were not significantly different between TB pleurisy and malignant effusion. Images for this section: Page 2 of 12

3 Fig. 1: Pleural TB-79/M combined lung lesion (-) Pleural and fissural nodular thickening Page 3 of 12

4 Fig. 2: Pleural TB-79/M combined lung lesion (-) Pleural and fissural nodular thickening Page 4 of 12

5 Fig. 3: Pleural TB-51/M Pleural and fissural nodular thickening Page 5 of 12

6 Fig. 7: Pleural TB- Parietal pleural thickening > 1cm Page 6 of 12

7 Fig. 6: Pleural TB-69/M Circumferential thickening Page 7 of 12

8 Fig. 5: Pleural and pulmonary TB- 35/F Pleural and fissural nodular thickening Page 8 of 12

9 Fig. 4: Pleural TB-50/F nodular (band-like)thickening with effusion Page 9 of 12

10 Fig. 8: Analysis of pleural or fissural nodules Page 10 of 12

11 Fig. 9: CT findings of pleural thickening Page 11 of 12

12 Conclusions About 44% of patients with tuberculous pleurisy showed circumferential pleural enhancement (35%) and nodular thickening (9%) on chest CT scan. Therefore, TB pleurisy should be included in differential diagnosis when these findings are seen at chest CT, especially in TB endemic area. Although these overlapping radiologic findings, the CT feature that was helpful in distinguishing malignant effusion from TB pleurisy was nodular pleural thickening Page 12 of 12

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