Multimodality Imaging of Pleural Disease: Framework for Diagnosis and Interpretation-Podcast скачать в хорошем качестве

Multimodality Imaging of Pleural Disease: Framework for Diagnosis and Interpretation-Podcast

Multimodality Imaging of Pleural Disease: A Practical Radiologic Framework for Diagnosis and Differential Interpretation Pleural diseases encompass a broad spectrum of conditions ranging from benign inflammatory processes to aggressive malignancies. Accurate radiologic evaluation is essential because pleural abnormalities often present with nonspecific clinical manifestations, and imaging frequently provides the first clue to diagnosis. This pictorial review provides a comprehensive overview of pleural anatomy, pathologic processes, and multimodality imaging features that guide differential diagnosis and clinical management. The pleura consists of the visceral and parietal layers separated by a thin film of physiologic fluid, typically measuring only 0.2–0.4 mm in thickness. Under normal conditions these layers are indistinguishable on imaging; however, disease processes such as pneumothorax, pleural effusion, pleural thickening, and pleural masses may render them visible. Multimodality imaging—including chest radiography, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and FDG PET/CT—plays a complementary role in evaluating these abnormalities and narrowing diagnostic possibilities. Chest radiography remains the initial imaging modality for detecting pleural pathology. Classic radiographic signs include the visceral pleural line in pneumothorax and the meniscus sign in pleural effusion. Ultrasonography offers superior sensitivity for small pleural effusions and dynamic evaluation of pleural motion; the presence or absence of lung sliding can help identify pneumothorax. CT provides the most detailed assessment of pleural morphology and adjacent thoracic structures, enabling detection of pleural thickening, nodularity, calcification, and associated parenchymal abnormalities. MRI further contributes tissue characterization, particularly in evaluating pleural tumors and differentiating fibrous from necrotic components, while FDG PET/CT aids in distinguishing benign from malignant processes and in staging pleural malignancies. Pleural effusion represents one of the most common manifestations of pleural disease and may result from transudative or exudative processes. Pleural thickening and pleural masses represent another important diagnostic category. Benign pleural thickening often appears as smooth, uniform, and diffuse, whereas malignant pleural disease frequently demonstrates nodularity, irregularity, mediastinal pleural involvement, and thickness exceeding 10 mm. Asbestos-related pleural plaques typically manifest as bilateral calcified plaques along the posterolateral chest wall or diaphragmatic pleura and may exhibit the classic “holly leaf” appearance. Infectious pleural diseases such as empyema and tuberculous pleuritis demonstrate distinctive imaging patterns. Empyema often appears as a lenticular pleural collection forming obtuse angles with the chest wall and may show septations or the split-pleura sign. Tuberculous pleuritis may mimic empyema but is frequently accompanied by pulmonary findings such as centrilobular nodules or cavitary lesions. Neoplastic pleural diseases are dominated by metastatic involvement, malignant pleural mesothelioma (MPM), and solitary fibrous tumors of the pleura (SFTP). Metastatic disease is the most common pleural malignancy and may present with effusion, nodularity, or circumferential pleural thickening. MPM typically demonstrates unilateral pleural thickening and a rind-like encasement of the lung, often involving mediastinal pleura and associated with asbestos exposure. In contrast, SFTP arises from subpleural mesenchymal cells and usually appears as a well-defined pleural mass that forms obtuse angles with the pleura; most cases are benign but large lesions may demonstrate malignant behavior. FDG PET/CT is particularly useful for assessing metabolic activity and guiding differentiation between benign and malignant pleural lesions. Overall, understanding the multimodality imaging features of pleural diseases is critical for radiologists. Integration of imaging morphology, distribution patterns, clinical history, and associated thoracic findings enables accurate diagnosis and appropriate recommendations for further investigation or management. Familiarity with key imaging signs can significantly enhance diagnostic confidence in daily clinical practice. APA (7th edition) citation of the source: Yamada et al. (2024). Pictorial review of pleural disease: Multimodality imaging and differential diagnosis. RadioGraphics, 44(4). Radiological Society of North America. Hashtags: #Radiology #MedicalEducation #PleuralDisease #MedEd #Lungs #UltrasoundTraining #ChestImaging #Pneumothorax #Mesothelioma #MedicalMysteries #ThoracicImaging #ChestCT #ImagingDiagnosis #RadiologyEducation #RadiologyAI #MedicalImaging #RSNA #RadiologyResearch © 2025 AI Chavelle™ by Jeffrey Chen / SmartRad AI. All rights reserved.