Parts
Size
Normal Size Abnormal Position
20-year-old female presents with acute left sided chest pain. She has asthenic build which raises the suspicion for a spontaneous pneumothorax. Frontal CXR shows a small subtle pneumothorax characterised by a thin pleural line (b, white arrowhead) and relative lucency of the left apex
Ashley Davidoff MD TheCommonVein.net 117246c01
Mildly Thickened Post Biopsy
This case shows a chest x-ray of a patient who had a lung biopsy which was complicated by a pneumothorax and a small amount of pleuroparenchymal hemorrhage. The two components of the pleural layer have been separated and the cohesive/adhesive forces have been disrupted by the air which now intervenes and disturbs the physics of the capillary action. The parietal pleura remains attached to the chest wall while the visceral pleura remains attached to the lung. This is a small pneumothorax and had no effect on the patient or the mechanics of lung movement. In this case we followed the patient with a CXR at 2 and 4 hours later. When no progression was demonstrated we allowed the patient to be discharged home with special instructions to limit activities till the next day. In this case there is an abnormal increase in the density of the visceral pleura
Ashley Davidoff MD TheCommonVein.net 42041b01
Mildly Thickened Post Biopsy
The above image is a magnified view of the pneumothorax.
Courtesy Ashley Davidoff MD TheCommonVein.net 42041b02
Parapneumonic Effusion – Empyema Thickened Pleura
CT scan in a 76-year-old male shows a left lower lobe consolidation (b, white arrowhead) associated with a loculated parapneumonic effusion with trapped air bubbles (b yellow arrowhead) which was culture positive and a thickened enhancing pleura
Ashley Davidoff MD TheCommonVein.net 136194cL
Shape
Position
Normal Size Abnormal Position
20-year-old female presents with acute left sided chest pain. She has asthenic build which raises the suspicion for a spontaneous pneumothorax. Frontal CXR shows a small subtle pneumothorax characterised by a thin pleural line (b, white arrowhead) and relative lucency of the left apex
Ashley Davidoff MD TheCommonVein.net 117246c01
Character
Time
Infection
Inflammation
Fibrofatty Pleural Reaction to
Chronic Aspiration and Atelectasis
b12388-03cL-b12388-03-lungs-RLL-atelectasis-probaly-chronic-aspiration-dx-fibrofatty-pleural-reaction-60M-C.png
Fibrofatty Pleural Reaction Associated with Chronic AtelectasisHistory
A 60-year-old male with chronic cough and a history suggestive of chronic aspiration.
Findings
Axial CT (a magnified in c) demonstrates bronchovascular thickening and crescentic atelectasis in the lateral segment of the right lower lobe (RLL) (red asterisk), and fatty proliferation along the pleural surface adjacent to the atelectasis (yellow arrowheads).
Coronal CT (b magnified in d ) reveals a rim of pleural fatty proliferation along the pleural surface adjacent to the atelectasis (red arrowheads) and fatty proliferation along the pleural surface adjacent to the atelectasis (yellow arrowheads).
Comment
The findings in the right lower lobe (RLL) represent chronic crescentic atelectasis, likely caused by chronic aspiration, accompanied by pleural fibrofatty proliferation.
? Chronic atelectasis leads to persistent pleural irritation and inflammation, stimulating localized fibrosis and reactive adipose tissue proliferation in the pleura.
? The bronchovascular thickening suggests chronic inflammatory changes, consistent with recurrent aspiration.
? The rim of fat proliferation (red arrowheads) adjacent to the atelectasis is a hallmark of chronic pleural inflammatory processes, often seen in chronic or localized injury.
Radiological Pearls
? Fatty proliferation appears as low-attenuation fat-density tissue (-50 to -150 HU) within the pleura, often seen adjacent to atelectatic lung segments.
? Crescentic atelectasis is indicative of subsegmental airway obstruction and recurrent lung collapse.
Ashley Davidoff MD TheCommonVein.net (b12388-03cL)(310Lu)