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Mesothelioma Radiology

Fluid accumulation in the pleural space Mesothelioma radiology can be diagnosed on the thorax image in the lateral position and horizontal beam path from 15 ml. They are detected more reliably by computer tomography or sonography. CT also helps differentiate empyema and abscess, the detection of small wasps, and pleural tumors and their precise location. Sonographically, even small free or encapsulated effusions of calluses or masses are demarcated. Magnetic Resonance Imaging is the expression of pleural effusions and masses, as well as thoracic wall infiltration of bronchial carcinomas or mesotheliomas.
Pleural plaques and calcifications are detectable to a limited extent on postero-anterior, lateral and oblique chest X-ray. A better representation succeeds computertomographisch.

The inside of the thorax is lined by the parietal pleura. The lungs are covered by the visceral pleura. Between the two adjoining pleural leaves is a thin liquid film. The pleura cannot be visualized in the X-ray image or in the new slice imaging procedure. The visceral pleura becomes visible only when air enters between the pleural leaves, these are distanced from each other (pneumothorax) and the pleura-coated lung is tangentially imaged. However, the adjacent visceral pleural leaves of the cleft gaps are recognizable in the computed tomogram with thin layers as a compression line.

In a computed tomographic or magnetic resonance tomographic cross-section of the thoracic wall, from inside to outside, as shown:
Lung tissue - subpleural fat lamella (1-2mm thick) - Intercostal muscle intimus - rib cortical bone.
The subpleural fat lamella has diagnostic significance. It is no longer present on tumor infiltration into the thoracic wall.


1. pleural effusion
The pleural space usually contains about 5 ml of free interstitial fluid. There is a balance between production and absorption of about 10 ml daily. Increased pleural fluid is called effusion. An effusion arises through

1. increased hydrostatic pressure (e.g., in case of increased venous and capillary pressure due to cardiac stasis)
2. reduced oncotic pressure (in case of nephrotic syndrome by hypoalbuminemia)
3. increased negative pressure in the pleural space (by atelectasis)
4. increased permeability in the microcirculation area (in case of inflammation or tumor)
5. Resorption disorder (due to fibrosis or tumor)
6. Transdiaphragmalen fluid transport via lymph vessels (abscess or pancreatitis).
Clinically important is the distinction between transudate and exudate. The transudate corresponds to non-resorbed interstitial fluid. The cause is usually cardiac congestion, including, inter alia, upper Einflussstauung or nephrotic syndrome. Exudate is caused by, among other things, infections, tumors or autoimmune diseases. It has a higher protein content than a transudate. Transudate and exudate cannot be differentiated radiologically.

An empyema is a collection of pus in the pleural space (if, for example, a lung abscess breaks into the pleural space).

A hemothorax is hemorrhage into the pleural space (eg in case of rib fracture).

Chylothorax exists in lymph in the pleural space, eg. in lymph fistulas or injury to the thoracic duct. Lymph drainage is via the visceral pleura.

It is clinically important to distinguish effusion and rind. An unabsorbed effusion went blank. This results in reduced mobility and reduced ventilation of the lungs. Narrow effusions are often not distinguishable from calluses in CT.

Sign of the pleural effusion in the radiograph:
Homogeneous basal compaction in standing patient
Rounding off the chest wall (meniscus sign) At least 200 ml, sometimes more, are necessary for the development of these signs.
The cleft spaces are widened when the effusion has entered (jumped in)
In the dying patient, the effusion runs out cranially.
in the dying patient, the shading fades from caudal to cranial, with pulmonary vessels still visible,
in the lying patient possibly rounding out the marginal sinus as in the standing thorax,
in the lying patient apical compression and lateral distancing of the lung from the thoracic wall by effusion.
as a result of this and by compression of the lower lobe, a surface compression parallel to the thorax wall can arise.
in the left lateral position and horizontal beam path forms a horizontal Ausstoßlamelle (DD callus, Matrazenkante, Wäschefalte). This is the most sensitive radiological proof of effusion. The lower detection limit is 15 ml
X-ray sign of the encapsulated pleural effusion.