대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1350 Date 2023-09-05

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  • Courtesy of Se Ri Kang, Ji Young Rho / Wonkwang University Hospital
  • Age/Sex 68 / M
  • Chief ComplaintSigmoid colon cancer (pT2N0M0) follow up No symptom
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
IgG4-related pleural disease
Radiologic Findings
Fig 1-3. Chest CT scans reveal multifocal enhancing pleural nodules with soft tissue thickening in right paravertebral area.
Brief Review
IgG4-related pleural disease manifests as unilateral or bilateral pleuritis with pleural effusion. On CT images, small pleural nodules, diffuse inflammatory pleural thickening, or pleural plaque can be seen. Paravertebral band-like soft tissue occurs in approximately 8% of IgG4-related disease. It is a major finding included in the 2019 ACR/EULAR criteria. It mainly occurs in the lower part of the thoracic spine, spanning two or more than vertebrae. It can be bilateral, but always involves the right side, which is thought to be related to the location of the thoracic duct. The band shape is most common, but can also be seen as nodular or infiltrative irregular shape. It appears as soft tissue on CT, isosignal intensity on T1 and T2 weighted images on MRI and homogeneous contrast enhancement on CT and MRI. The anterior portion of the spine adjacent to the mass may be extremely rarely involved.
References
Kim YK, Choi HY. Immunoglobulin G4-Related Disease in the Thorax: Imaging Findings and Differential Diagnosis. J Korean Soc Radiol 2021;82(4):826-837.
Keywords

No. of Applicants : 83

▶ Correct Answer : 15/83,  18.1%
  • - Chonnam National University Hwasun Hospital , Korea (South) KWANGKUN CHO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Chonnam National University Hwasun Hospital , Korea (South) SEONGWOO CHO
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chonnam National University Hospital , Korea (South) GYERYEONG PARK
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Fukuoka university , Japan KEISUKE SATO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - Kyoto university , Japan AKIHIKO SAKATA
▶ Correct Answer as Differential Diagnosis : 12/83,  14.5%
  • - , Japan KYOKO NAGAI
  • - , Japan AYUMI KAMEI
  • - Chonnam National University Hospital , Korea (South) JUNYEOL YANG
  • - Other , Korea (South) SEONGSU KANG
  • - Osaka University , Japan AKINORI HATA
  • - OITA UNIVERSITY , Japan FUMIKA ISHITOBI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Japan MIYUKO FUJITA
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
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