Clinical inforeason for study 87 year male underwent CT Chest to investigate abnormal CXR' Ho mitral

1
Clinical info/reason for study87 year male
underwent CT Chest to investigate abnormal
CXR.H/o mitral valve replacement, pacemaker
implantation.
2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
Differential diagnosisLung cancerPleural
tumorPE with infarct
6
Diagnosis Round Atelectasis
7
Round AtelectasisPathology- Retracting
pulmonary scar causing invagination of parietal
pleura and infolding of lung.Etiology- Hanke
and Kretzschmar-Pleural effusion causes passive
atelectasis and infolding of visceral pleura.
Fibrinous parietal pleural adhesions maintain the
infolding. As effusion resolves, lung reexpands
except atelectatic lung.Schneider-Asbestos
related- Contraction of visceral pleura
thickening with retraction of parenchymal
fibrosis. Asbestos exposure in 65 cases.
Congestive heart failure, pulmonary infarct,
Dressler syndrome, parapneumonic effusion,
tuberculous effusion and non nonspecific
pleurisy can precede its formation.
8
CT Single or more than one wedge shaped,
lentiform or irregular opacity, juxtapleural in
location. Usually in posterior or posteromedial
segment of lower lobes. Forms acute angle with
pleura. Distortion, displacement and convergence
of bronchovascular structures into the mass -
Comet tail sign. Volume loss of the adjacent
lung. Pleural thickening is always present,
usually greatest near the mass. Air bronchogram
may be seen in 60.CECT- Homogenous enhancement.
9
MRI- On T1WI, round atelectasis shows signal
intensity higher than muscle and lower than fat.
Convergence of pulmonary vessels and bronchi
better seen on sagittal and coronal planes.
Infolded visceral pleura is seen as low SI line.
On T2, similar or lower than fat. Homogenous
enhancement on gadolinium administration.PET-
Not metabolically active and is rarely
positive.US- Highly echogenic line extending
into the mass from the pleural surface- may
represent scarred invaginated pleura.
10
Treatment and Natural history- Treatment aimed at
underlying cause. May progress over years. May
remain stable, grow very slowly or shrink or
disappear.