Computed tomography in the evaluation of pleural dissemination in lung cancer

A total of 19 patients with lung cancer were recognized as unresectable or not curatively resectable at thoracotomy due to pleural dissemination during the period from January 1984 to March 1989. The computed tomography films of these cases were reviewed retrospectively to search for clues of early detection of pleural dissemination in order to avoid unnecessary exploration. The findings of the pleura in these 19 patients included: fine pleural nodules in 12 cases, pleural thickening in 11, pleural surface irregularity in 10, direct pleural attachment of the tumor in 8, pleural retraction by the tumor in 7, pleural effusion in 5, and chest wall invasion in 5. In this series, 15 out of the 19 cases had at least one of the following three findings: pleural thickening, pleural surface irregularity or pleural nodules. These pleural changes on a chest CT should raise the suspicion of pleural dissemination. An additional diagnostic procedure to establish diagnosis before exploration is suggested.