E1316. I’ve Got Something to Get off My Chest: A Memoir of Pleural-Based Lesions
  1. Dhagash Mehta; Icahn School of Medicine at Mount Sinai
  2. Florence Doo; Stanford University Medical Center
  3. Mamatha Gowda; Icahn School of Medicine at Mount Sinai
  4. Jose Concepcion; Icahn School of Medicine at Mount Sinai
Various benign, malignant (primary and secondary), or tumorlike lesions can arise from the pleura. Radiographically, these lesions may present with varied, yet overlapping imaging characteristics. Accordingly, radiologists must have a thorough understanding of various pleural-based lesions and their imaging characteristics to provide diagnoses that are more accurate. The purpose of this exhibit is to provide a case-based review of pleural-based pathologies and their mimicking differential diagnoses with imaging from our institution.

Educational Goals / Teaching Points
This exhibit aims to illustrate the cross-sectional imaging characteristics of common and uncommon pleural lesions, including anatomical landmarks and pertinent imaging findings. Additionally, we will highlight differential diagnoses to help radiologists better identify mimics and their overlapping features, improving diagnostic accuracy. Finally, the clinical implications and management options of various pathologies will be reviewed, particularly to differentiate benign versus malignant processes to help clarify follow-up and reduce unnecessary interventions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We present a multimodality review of imaging techniques for the evaluation of pleural-based tumors. This includes neurofibroma, thoracolith ("pleural mouse"), lymphoma, malignant mesothelioma, metastases, solitary fibrous tumor, lipoma (versus extra-pleural fat), extra-medullary hematopoiesis, and others. Often, initial evaluation includes chest radiography and Computed Tomography (CT). While plain film imaging findings can often be nonspecific, this exhibit will discuss imaging findings to help differentiate pleural from pulmonary tumors, using characteristics such as tumor location and angle with the chest wall (acute vs. obtuse), mass effect, and "incomplete border" sign. On the other hand, CT scans have a reported sensitivity of 88% - 100% for detecting malignant pleural disease, but specificity is 40% - 45%. Accordingly, this exhibit will also aim to review the classic CT appearance of various pleural-based tumors, specifically highlighting benign vs. malignant attributes. This includes characteristics such as tumor shape/margin and features (calcifications, necrosis, hemorrhage), enhancement pattern, laterality, pleural thickening/effusion, rib erosion, and lymph node involvement. Lastly, we will provide examples of when further correlation is required with Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), or tissue sampling.

It is estimated that the incidence of uncommon pleural tumors is approximately 3 cases per 100,000 hospitalizations in North America. Due to their rarity, imaging exposure to pleural-based tumors may be limited at many institutions; however, radiologists must be aware of the pertinent imaging features of various pleural-based tumors to provide accurate and timely diagnoses. This can help reduce patient anxiety, avoid unnecessary biopsies and surgical interventions, and improve clinical outcomes.