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Related Experiment Videos

Parietal pleural changes in empyema: appearances at CT.

R J Waite1, R J Carbonneau, J P Balikian

  • 1Department of Radiology, University of Massachusetts Medical Center, Worcester 01655.

Radiology
|April 1, 1990
PubMed
Summary

Computed tomography (CT) effectively detects parietal pleura changes in thoracic empyema. These CT findings, including pleural enhancement and thickening, help identify infections and guide treatment decisions.

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Area of Science:

  • Radiology
  • Thoracic Imaging
  • Medical Diagnostics

Background:

  • Pleural effusions are common and can be challenging to diagnose.
  • Differentiating between empyema, malignant effusion, and transudatory effusion is crucial for patient management.
  • Computed tomography (CT) is a key imaging modality for evaluating pleural abnormalities.

Purpose of the Study:

  • To evaluate the sensitivity of contrast-enhanced CT in detecting chest wall changes associated with thoracic empyema.
  • To compare CT findings in patients with empyema, malignant effusion, and transudatory effusion.
  • To determine if CT findings can aid in diagnosing occult pleural space infections and influencing therapeutic decisions.

Main Methods:

  • Retrospective analysis of computed tomography (CT) scans.

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  • Inclusion of 35 patients with thoracic empyema, 30 with malignant effusion, and 20 with transudatory effusion.
  • Detailed assessment of parietal pleura and adjacent chest wall structures, including enhancement, thickening, and fat attenuation, particularly after contrast administration.

    • Main Results:

    • Parietal pleural enhancement was observed in 96% of empyema patients undergoing contrast-enhanced CT.
    • Significant thickening of the parietal pleura (86%), extrapleural subcostal tissues (60%), and increased extrapleural fat attenuation (35%) were noted in empyema.
    • None of the transudatory effusion patients exhibited these changes; 27% of malignant effusion patients showed similar changes, often with superimposed complications.

    Conclusions:

    • Contrast-enhanced CT is highly sensitive for detecting chest wall abnormalities in thoracic empyema.
    • CT evaluation of the parietal pleura can suggest occult pleural space infections.
    • These findings may significantly influence therapeutic strategies based on empyema staging.