Computed tomography in the evaluation of pleural dissemination of lung cancer

Pleural dissemination of a tumor is one of the most important factors in the clinical diagnosis of lung cancer. A positive finding suggests that the surgical procedure would be absolutely non-curative even if a panpleuro-pneumonectomy were performed. The radiographic method, especially computed tomography (CT) with its cross-sectional format, has great potential for diagnosing diseases that affect the pleura. CT images and conventional roentgenograms of 11 patients with pleural dissemination of lung cancer who underwent thoracotomy were retrospectively reviewed. All of these cases were recognized intra- or postoperatively to have tumor dissemination to the chest wall. In 8 out of 11 cases, tumor dissemination was recognized not only in the chest wall but also in interlobar fissures. The 3 remaining cases had no tumor dissemination in interlobar fissures. Of the 11 cases, preoperative CT images revealed an irregular surface of the chest wall and/or pleura in 5 out of 11 cases. CT also clearly showed multiple small nodular densities in the ipsilateral interlobar spaces in 7 out of the 8 cases with dissemination in the interlobar fissures. A relatively small amount of pleural effusion, which was recognized in 4 out of 11 cases intraoperatively, was detected in 2 cases by CT . Conventional roentgenograms, however, had less potential for detecting these findings. CT has an important role in the clinical diagnosis of pleural dissemination of lung cancer, especially in the interlobar spaces. (author)