Dear Friends,
Dr. Pepe is busy preparing next week’s webinar (click here to register!) and asked me to present a case this week. The case is provided by my friend Jordi Andreu.
Radiograph belong to a 83-year-old woman with dementia. A mass was detected in the right lung and a CT was done.
What do you think?
Click here to see the images
Click here to see the answer
Findings: AP chest radiograph shows a well-defined opacity in the right upper hemithorax (A, arrow) which appears to be extrapulmonary. There are calcified granulomas in the left apex with retraction of the left hilum.
Unenhanced axial and coronal CT show an extrapulmonary mass with a calcified rim (B-C, arrows). The mass has a striated appearance, alternating lineal areas of different opacities. This CT appearance is practically pathognomonic of oleothorax (see case 19 of Caceres’ corner).
Instillation of oil in the extrapleural space (oleothorax, plombage) was used to collapse the lungs facilitating healing of TB cavities. It was abandoned in the early fifties after the discovery of effective antimicrobial therapy.
The patient had pulmonary TB in her youth and told us that it was treated by instillation of a substance. A clinical photograph in another patient (D) documents the surgical scar.
Final diagnosis: Oleothorax
Congratulations to Diogo, who was the first to make the diagnosis and to Jake, who concurred two days later.
Teaching point: this is an uncommon pathology, but it should be known because the appearance is pathognomonic and shouldn´t be confused with other conditions. This patient was seen four weeks ago and diagnosed initially of pleural tumour.
Good morning!!
There is an extrapulmonary right lesion with pleural calcifications. The lesion has various densities like soft tissue and fat/cystic degeneration with pleural thickened. I think it can be a fibrous pleural tumour.
Rt upper hemithorax extrapulmonary mass, absent anterior portions of ribs, contralateral lung appex calcifications, and old patient. Looks pathognomonic…
Pleural based lesion engulfed with peripheral calcification …likely mesothelioma
Don’t tell anybody!!
Chronic empyema
There is a well defined extra-pulmonary lesion in the upper aspect of the right hemithorax with peripheral calcifications, most suggestive of solitary fibrous tumor of the pleura.
Large extrapulm mass with smooth margin with calcifications. Rib destruction +.
No pl effusion.
Mesothelioma in ddx
So far only one of you has made the correct diagnosis 🙂
empyema?
RUZ extrapulmonary, intrapleural oval hypoattenuated lesion with calcified viseral pleura and Left apical fibrosis suggestive of Chronic Koch’s LUZ and chronic empyaema and granulation tissue at right upper zone pleural space
looks like a plombage with oil/paraffin in the past
CHRONIC EMPYEMA
There is visible calcified tuberculoma in left pulmonary appex,maybe pleuritis Tb chronica on he contralateral side?
Extrapulmonary,pleural calcified mass,mainly soft tissue density,well demarcated…Solitary fibrous tumor of pleura
Oval shape soft tissue mass pleural based is detected right hemithorax , extrapulmonary , with peripheral calcification , no lymphadenopathy, giving impression of pleural tumor ..? Pleural fibroma