Case presentation : 58 years old, man
chief complaints:The chest X-ray unusual
shadow
Incumbent medical history :
Life was done cheerfully so far, and he had
the chest unusual shadow pointed
out by the periodic medical examination in
this April, and examined with the
energy purpose.
At the time of the hospitalization, present
status:
Breathing sound is a little weak, and there
is a sonant even in the percussion
in the bottom right pulmonary field .
blood pressure 142/76, the one for the pulse
80/, temperature 36.6C, chest
auscultation were examined .
Leukocyte 6000, CRP 0.5m g/dl, erythrocyte
sedimentation rate45mm /1hr,
81mm /2hr, PPDs skin test 10mm
high resolution CT
Radiologist comment :
Encapsulated pleural effusion is recognized
on the right side, and mass lesion
which is located adjacent the effusin is
seen.
A blood vessel and a bronchus are involved
in this mass, and it is considered
with comet-tail sign, and it is diagnosed
as rounded atelectasis on CT.
The chest MRI comment :
This patient was pointed out to have abnormal
chest X-ray findins on the regular medical
examination .
Antero-postero chest X-ray film reveals abnormal
shadow in the right lower
lung field, and this shadow was diagnosed
as encapusulated pleural effusion
and rounded atelectasis.
Active lesion of tuberculosis can not be
detected in the lung field, and pleuritis
was considered as tuberculous pleuritis causedby
primary tuberculous foci.
Though pleural tap was done, aspiration of
pleural effusion could not be
possible because of encapusulated effusion
and fibrin formation in the pleural
space.
Treatment by RFP and INH was started as a
tuberculosis pleuritis.
Comment:
Round atelectasis is named for 1971 by Hanke,
and Furukawas are reporting
it for 1981 first as "atelectasis with
tumor-like shadow" in Japan.
the journal of clinical radiology 1981; 26:1063-1066.
Elderly male has the tendency to have this
disease ,and the location of the
disease is predominantly in lower lobe. 80%
of the rounded atelectasis are
located in this area.
Characteristics on the X-ray findings are
2-5cm rounded tumor shadow
adjacent to localized thickened pleura, and
so-called comet tail sign which
is composed of converging bronchus and blood
vessels around the lesion.
The findings of MRI is very interesting.
In T1 image, tumor reveals mid-density between
muscle and vertebral bone,
and is enhanced homogeneously by gadrinium.
It was diagnosed as round atelectasis because
of the exsiting bronchus
structure in the lesion.
Encapsulated pleural was highly enhanced
by gadrinium, and was digagnosed
as active pleuritis.
It considers that MRI is useful for the diagnosis
of the existence of the
activities of the pleuritis as well.
high resolution CT