CT Manifestations of Late Sequelae in Patients with Tuberculous Pleuritis
Jung-Ah Choi1,
Ki Taek Hong1,
Yu-Whan Oh1,
Myung Hee Chung2,
Hae Young Seol1 and
Eun-Young Kang1
1
Department of Diagnostic Radiology, College of Medicine, Korea University,
Korea University Guro Hospital, 80 Guro-dong, Guro-ku, Seoul 152-050,
Korea.
2
Department of Radiology, Holy Family Hospital, Catholic University,
Sosa-2-dong, Wonmi-gu, Pucheon city, Kyunggi-do 420-717, Korea.
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Fig. 1. —Pleural thickening in 64-year-old man diagnosed with
tuberculous pleuritis 3 years earlier. CT scan shows diffuse pleural
thickening with areas of calcifications (arrows) in right
hemithorax.
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Fig. 2. —Fibrothorax in 25-year-old woman. Radiographs of chest (not
shown) obtained 6 months earlier revealed incidental abnormalities. CT scan
shows extensive pleural thickening encompassing right hemithorax, which is
decreased in volume.
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Fig. 3. —Fibrothorax in 74-year-old man. CT scan shows extensive
pleural thickening with calcifications in left hemithorax. Note loss of
volume. Also, note adjacent rib hypertrophy and prominent epipleural fat pads
(arrows), suggesting chronic benign pleural disease.
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Fig. 4. —Chronic tuberculous empyema in 66-year-old man diagnosed with
tuberculous pleuritis 23 years earlier. CT scan obtained at level of lower
thorax shows large loculated pleural fluid collection in right lower lateral
hemithorax. Note surrounding pleural thickening and calcifications.
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Fig. 5. —Chronic persistent pleural effusion in 40-year-old man. CT
scan shows lenticular-shaped chronic loculated pleural effusion enclosed by
calcified pleural layers in left lateral hemithorax. Note loculated fluid is
near soft-tissue density (arrow), indicating chronicity of loculated
content.
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Fig. 6A. —Empyema necessitatis in 23-year-old man. CT scans reveal
thick-walled, bilobed fluid collection involving both pleural cavity
(A) and adjacent chest wall (B) without adjacent rib
destruction. Direct communication between pleural (arrows, A)
and chest wall fluid collection (arrows, B) is not shown on
this CT scan. Patient had history of tuberculous pleuritis 5 years ago and
presented with chest pain of 1-2 months' duration. He underwent surgery and no
rib destruction was found, consistent with findings on CT.
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Fig. 6B. —Empyema necessitatis in 23-year-old man. CT scans reveal
thick-walled, bilobed fluid collection involving both pleural cavity
(A) and adjacent chest wall (B) without adjacent rib
destruction. Direct communication between pleural (arrows, A)
and chest wall fluid collection (arrows, B) is not shown on
this CT scan. Patient had history of tuberculous pleuritis 5 years ago and
presented with chest pain of 1-2 months' duration. He underwent surgery and no
rib destruction was found, consistent with findings on CT.
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Fig. 7. —Empyema necessitatis in 25-year-old man. CT scan shows
bilobed fluid collection along pleura and another unilocular fluid collection
along adjacent outer chest wall (arrows) in right hemithorax. Center
of fluid collections is located in intercostal space, and no definite evidence
of rib destruction is present. At surgery, no evidence of rib destruction was
found, consistent with CT findings.
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Fig. 8A. —Bronchopleural fistula in 57-year-old man diagnosed with
tuberculous pleuritis 3 years earlier. CT scans obtained at lung window
setting reveal extensive nodular pleural thickening (arrows,
A) extending for more than two thirds of circumference of right
hemithorax (A) and allow direct visualization of fistula between
bronchus and pleural cavity (arrow, B). Active cavitary
pulmonary tuberculosis is noted in left lung, which suggests cause of
bronchopleural fistula is reactivated tuberculosis.
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Fig. 8B. —Bronchopleural fistula in 57-year-old man diagnosed with
tuberculous pleuritis 3 years earlier. CT scans obtained at lung window
setting reveal extensive nodular pleural thickening (arrows,
A) extending for more than two thirds of circumference of right
hemithorax (A) and allow direct visualization of fistula between
bronchus and pleural cavity (arrow, B). Active cavitary
pulmonary tuberculosis is noted in left lung, which suggests cause of
bronchopleural fistula is reactivated tuberculosis.
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Fig. 9A. —Bronchopleural fistula in 68-year-old man diagnosed with
tuberculous pleuritis 20 years earlier. At presentation, patient had known
about his tuberculous empyema for 6 years but had refused treatment. CT scans
obtained at lung (A) and soft-tissue (B) window settings at
level of mid chest reveal extensive parietal and visceral pleural thickening
and calcification with loculated pneumothorax in right hemithorax. Also note
loss of volume of hemithorax.
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Fig. 9B. —Bronchopleural fistula in 68-year-old man diagnosed with
tuberculous pleuritis 20 years earlier. At presentation, patient had known
about his tuberculous empyema for 6 years but had refused treatment. CT scans
obtained at lung (A) and soft-tissue (B) window settings at
level of mid chest reveal extensive parietal and visceral pleural thickening
and calcification with loculated pneumothorax in right hemithorax. Also note
loss of volume of hemithorax.
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Fig. 10A. —Bronchopleural fistula in 56-year-old man with history of
multidrug-resistant tuberculosis. Initial CT scans obtained at mediastinal
(A) and lung (B) window settings show extensive pleural
thickening, calcifications in visceral and parietal pleurae, air—fluid
level (arrowheads, B) within pleural space, and minimal
peripheral lung opacity, and findings suggestive of bronchiectasis
(arrow, B) and atelectasis in adjacent lung.
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Fig. 10B. —Bronchopleural fistula in 56-year-old man with history of
multidrug-resistant tuberculosis. Initial CT scans obtained at mediastinal
(A) and lung (B) window settings show extensive pleural
thickening, calcifications in visceral and parietal pleurae, air—fluid
level (arrowheads, B) within pleural space, and minimal
peripheral lung opacity, and findings suggestive of bronchiectasis
(arrow, B) and atelectasis in adjacent lung.
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Fig. 10C. —Bronchopleural fistula in 56-year-old man with history of
multidrug-resistant tuberculosis. Follow-up CT scans obtained at mediastinal
(C) and lung (D) window settings after 13 months show more
extensive pleural thickening, calcifications, increased lung opacity, and
atelectasis with bronchiectasis in adjacent lung parenchyma.
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Fig. 10D. —Bronchopleural fistula in 56-year-old man with history of
multidrug-resistant tuberculosis. Follow-up CT scans obtained at mediastinal
(C) and lung (D) window settings after 13 months show more
extensive pleural thickening, calcifications, increased lung opacity, and
atelectasis with bronchiectasis in adjacent lung parenchyma.
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Fig. 11A. —Adenocarcinoma associated with chronic tuberculous empyema of
30 years' duration in 69-year-old man. CT scans of right lower hemithorax show
soft-tissue mass lesion (arrows, A), which extends to
posterior chest wall with adjacent rib destruction and is enhanced
heterogeneously (B). Note adjacent extensive pleural thickening and
calcifications.
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Fig. 11B. —Adenocarcinoma associated with chronic tuberculous empyema of
30 years' duration in 69-year-old man. CT scans of right lower hemithorax show
soft-tissue mass lesion (arrows, A), which extends to
posterior chest wall with adjacent rib destruction and is enhanced
heterogeneously (B). Note adjacent extensive pleural thickening and
calcifications.
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