대한흉부영상의학회 Korean Society of Thoracic Radiology GuerBet

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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 58 Date 1998-12-07

  • Courtesy of Yo Won Choi, M.D. / Hanyang University Hospital
  • Age/Sex 38 / M
  • Chief Complaintright chest pain for two months
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Tuberculosis of pleura and manubriosternal junction
Radiologic Findings
Chest radiographs shows pleural lesion in the right hemithorax. Enhanced chest CT shows nodular pleural thickening in the right side. Pleural thickening is also seen in the anterior medistinal plural surface. CT also shows a well-defined osteolytic lesion involving manubriosternal junction with internal gas bubbles.
Brief Review
In a report by Leung et al (1), features that are helpful in distinguishing malignant from benign pleural disease are 1) circumferential pleural thickening, 2) nodular pleural thickening, 3) parietal pleural thickening greater than 1 cm, and 4) mediastinal pleural involvement. However, similar features are frequently seen in patients with pleural empyema (2) In addition, associated manubriosternal joint involvement in this patient favors the diagnosis of infectious origin. Monoarticular disease should include the differential diagnosis of tuberculous arthritis.
References
1. Leung AN, Muller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR 1990; 154:487-492
2. Na E-S, Kim Y-N, Lee M-R. Differential diagnosis of tuberlous pleural effusion and malignant pleural effusion: CT accuracy and findings. J Korean Radiol Soc 1997; 37:1059-1065
Keywords
Pleura, Chest wall, Infection, Bacterial infection, tuberculosis, Tuberculosis of pleura and manubriosternal junction

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