Pleural hypertrophy

Introduction The pleura is a layer of serosa that covers the surface of the lungs and the inner side of the thorax. They are called the visceral and parietal pleuras. The two pleuras form a gap called the pleural cavity. Under normal circumstances, the pleural cavity contains only a small amount of serum, which acts as a lubricant to reduce the friction between the two layers of pleura and prevent adhesion. Pleural hypertrophy is first caused by pleurisy. There are two types of pleurisy, one is dry pleurisy (without pleural effusion) and the other is exudative pleurisy (with pleural effusion). The production of pleural hypertrophy is mainly due to the second type of pleurisy.

Cause

Causes of pleural hypertrophy

Because the pleural effusion was not detected and pumped in time, the pleural effusion stayed in the pleural cavity for a long time. The pleural effusion stimulated the pleura, and fibrin was attached to the chest wall in the pleural effusion, so the pleural hyperplasia was thickened. Therefore, patients suffering from pleural effusion should go to the hospital for treatment in time, otherwise it will easily produce pleural hypertrophy.

an examination

Related inspection

Chest CT scan of chest flat film

Clinical manifestations:

Symptoms vary, but there are common symptoms such as chest pain or difficulty breathing. The clinical diagnosis is based on the history of pleurisy and imaging findings.

Imaging performance:

Localized pleural thickening and adhesions are common at the rib angles, making the rib angles dull, lighter, or flattened. Under the fluoroscopy, it can be seen that the transverse movement is weakened. The pleura can also have a wide range of layer thickening and adhesion. If the thickness is not large, and it is located in the front chest wall or the back chest wall, it can not cause obvious X-ray changes. When the pleural thickening reaches a certain thickness, the affected side is made. The lung field density increases, and when turned to the tangent position, there is a sharp sharp shadow on the inner edge of the thorax and the lung field. A large amount of pleural thickening and adhesion can cause the rib space to shrink, the mediastinum shifts to the affected side, the spine is convex toward the opposite side, and the diaphragm rises. A wide range of lesions can cause the hilar to be lifted and the trachea displaced to the affected side. There is also a cord-like pleural adhesion, which is easier to see when the pneumothorax and lung are collapsed. It is shown that there is a densely connected cord-like dense shadow between the chest wall and a lung surface. Cable-like pleural adhesions are often pleural changes caused by lung lesions close to the pleura. Common in tuberculosis and occurs in the upper lungs. Observing the sacral movement under fluoroscopy can identify localized pleural thickening and adhesions with a small amount of pleural effusion.

Differential diagnosis

Differential diagnosis of pleural thickening:

Pleural adhesion: It is the adhesion of the two layers of the pleura. This lesion is caused by tuberculosis, pleurisy, and chest injury. Patients seen in the clinic often have both pleural thickening and pleural adhesions. The clinical symptoms vary, but there are common symptoms such as chest pain or difficulty breathing.

Pleural metastasis: mainly from the lungs, followed by the breast, other common primary sites are the stomach, ovary, pancreas and so on. Cancer causes pleural capillary pressure, colloid osmotic pressure, capillary permeability and intrathoracic pressure changes, resulting in pleural effusion - malignant pleural effusion. Malignant pleural effusion, also known as cancerous pleurisy, is a pleural effusion caused by cancer pleural metastasis and pleural cancer itself. Malignant pleural effusion is a common complication of advanced cancer. Once a pleural effusion occurs in a cancer patient, it means that the lesion has spread locally or in the body.

Pleural calcification: There may be calcium salt deposition in the presence of organic blood clots or necrotic material in the pleural cavity, resulting in pleural calcification, more common in tuberculous pleurisy, suppurative pleurisy and injurious hemothorax. Some pneumoconiosis, such as talc lung and asbestosis, may also have pleural calcification and are often bilateral. Pleural calcification often coincides with pleural thickening and adhesion.

Pleural effusion: a potential pleural cavity between the visceral and parietal pleura. Under normal circumstances, the pleural cavity contains a small amount of liquid, which makes the two pleuras lubricate during respiratory movement, reducing friction, and its production and absorption often In dynamic balance. Pleural effusion occurs when any pathological condition accelerates its production and/or reduces its absorption.

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