대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

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