대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1188 Date 2020-07-29

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  • Courtesy of Eun Young Kim / Gachon University Gil Medical Center
  • Age/Sex 45 / F
  • Chief ComplaintNo specific symptom / PHx: breast cancer operation
  • Figure 1
  • Figure 2
  • Figure 3

initial

Diagnosis With Brief Discussion

Diagnosis
Thoracolithiasis
Radiologic Findings
Figure 1. CT shows a small calcified nodule at Lt. upper posterior hemithorax.
Figure 2. CT shows a small calcified nodule at Lt. middle anterior hemithorax.
Figure 3. CT shows a small calcified nodule at Lt. lower posterior hemithorax. It seems to migrate freely within the pleural cavity
Brief Review
Thoracolithiasis (also known as pleural stone, intrathoracic calculus or pleurolith) is a rare benign condition, in which one or more free bodies with or without calcification exist in the thoracic cavity without any previous trauma, intervention, or pleurisy. Thoracolithiasis is rarely symptomatic, and most of the cases were found incidentally on radiographs, CT scans, or at the time of surgery. The incidence in the general population is significantly low (0.086%) with the nodule size ranging between 5 and 15 mm (average size 8 mm). The lesions are mainly located on the left side. There is no age or sex predilection. Although most of the nodules are calcified, about one third of the lesions lack calcification. Calcified thoracolithiasis is usually located inferiorly, presumably secondary to the effect of gravity, and seems to migrate freely within the pleural cavity. On CT scan, theses nodules are usually ovoid and smoothly marginated, with different locations on serial scans due to mobility. Most of them are calcified without or with central low density due to fat. In the literature had an MRI, which showed the nodule containing a high-intensity area in the center on both T1-weighted and T2-weighted images, suggesting a soft tissue, probably fat.
References
1.Tanaka D, Niwatsukino H, Fujiyoshi F, et al. Thoracolithiasis
Keywords

No. of Applicants : 59

▶ Correct Answer : 36/59,  61.0%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - , Korea (South) JIN YOUNG LEE
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan KAZUMA TERAUCHI
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , Korea (South) HYUNGYU LEE
  • - Asan Medical Center , Korea (South) HYEMIN AHN
▶ Semi-Correct Answer : 1/59,  1.7%
  • - McGill University Health Center , Canada Alexandre Semionov
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