Pleural inflammation CT manifestations

Written by Shen Jiang Chao
Radiology
Updated on September 19, 2024
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The causes of pleurisy mainly include tuberculous, purulent, bacterial, tumorous, traumatic, and rheumatic types, with the tuberculous type being the most common. Pleurisy is predominantly characterized by pleural effusion, which generally looks similar on a CT scan. CT scans cannot distinguish the cause of pleurisy. A small amount of pleurisy manifests as a minor amount of free effusion, appearing as an arc or crescent of uniform density along the posterior chest wall. As the effusion gradually increases to a moderate or large amount, it can compress lung tissue, leading to compressive atelectasis. In cases of large volume effusion, aside from causing atelectasis, it can also significantly push the mediastinum towards the healthy side.

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Written by Wu Xiao Sheng
Pulmonology
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Is tuberculous pleurisy contagious?

Tuberculous pleurisy generally does not transmit. Tuberculous pleurisy is a special clinical type of tuberculosis, caused by the proliferation of Mycobacterium tuberculosis on the pleura. Tuberculous pleurisy can cause symptoms such as afternoon low fever, night sweats, weight loss, and even chest tightness and shortness of breath. However, since tuberculous pleurisy is not open tuberculosis, it does not release the tuberculosis bacteria into the environment, and thus lacks a definitive transmission route. Hence, tuberculous pleurisy is mostly not contagious to others. Although tuberculous pleurisy is an infectious disease, its infectivity is extremely low.

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Written by Wang Chun Mei
Pulmonology
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Can pleurisy cause hemoptysis?

Pleurisy, this disease in clinical practice, does not cause symptomatic hemoptysis on its own. This is because pleurisy is mainly due to bacterial invasion into the pleural cavity causing inflammatory lesions. The pleural cavity is a sealed space, which, when inflamed, often causes symptoms such as fever, cough, chest tightness, shortness of breath, and breathing difficulties when there is a significant accumulation of fluid in the chest cavity. Generally, it does not cause hemoptysis. There is only one possibility, for example, intense irritative coughing in patients with pleurisy may rupture the capillaries in the bronchial walls. In this case, patients might experience varying degrees of coughing with blood, but this is not a direct clinical symptom caused by pleurisy itself.

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Written by Yuan Qing
Pulmonology
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Sequelae of pleurisy with pulmonary effusion

The main sequelae of pleurisy with pleural effusion are pleural adhesions, which can affect respiratory function. Pleurisy is mostly caused by infectious diseases, although a portion is also due to non-infectious diseases. In the case of pleural effusion caused by infectious diseases, it contains a large amount of fibrinogen, which has the function of adhering to our pleura, thereby causing the pleura to thicken. At this time, the pleura will compress our lungs, significantly reducing the respiratory volume of our lungs, which greatly affects our respiratory function. Patients mainly exhibit symptoms such as shortness of breath, chest tightness, and rapid breathing even with slight activity or while lying in bed. Therefore, if pleurisy is detected, it is crucial to drain the fluid from the patient as soon as possible to avoid delaying treatment and the subsequent development of severe sequelae.

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Written by Yuan Qing
Pulmonology
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What should I do about pleurisy calcification?

Pleural calcification, mainly results from long-term unresolved pleuritis or inadequate timely treatment, causing adherence between the two pleural layers. Following this adhesion, calcium salts may deposit, leading to calcification. Usually, the primary consideration is whether the patient's lung function has been impacted. If so, a thoracotomy and pleural decortication might be performed to restore the pleural structure. If the patient only shows pleural calcification on imaging without significant discomfort, it may be observed without immediate intervention, and regular monitoring of the calcification is recommended to see if it enlarges. If the condition remains stable over time, it might not require treatment since this represents a tendency towards healing, or the residual scarring may not necessitate special management.

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Written by Wang Chun Mei
Pulmonology
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What is the cause of hemoptysis in pleurisy?

Pleurisy is generally more commonly seen in young adults and children clinically, and is most commonly caused by an infection of the pleura by Mycobacterium tuberculosis. Usually, patients with this type of pleurisy do not experience symptoms of coughing up blood. The typical symptoms caused by pleurisy primarily include chest pain, coughing, chest tightness, shortness of breath, and in severe cases with a lot of pleural effusion, it can cause the patient to experience breathing difficulties and sometimes chills. Therefore, the clinical symptoms presented by different patients can vary. When a patient with pleurisy has a severe cough, it can lead to the rupture of the capillaries in the bronchial walls, which can cause the patient to have varying degrees of blood in the sputum, or even coughing up blood.