Malignancy associated with chronic empyema: radiologic assessment.

Abstract

Radiologic findings of six cases of malignancy associated with chronic empyema 5-39 years in duration were reviewed. Pathologic examination confirmed three B-cell non-Hodgkin lymphomas, one round-cell sarcoma, one mesothelioma, and one adenocarcinoma. Retrospective findings on plain chest radiographs suggested the occurrence of malignancy: increased radiopacity in the thoracic cavity, soft-tissue bulgings and/or unsharpness of fat planes in the chest walls, destruction of bone near the empyema, and extensive medial deviation of the calcified pleurae. Computed tomography delineated masses with soft-tissue attenuation more clearly than radiography in all cases. Magnetic resonance images of three cases were informative because empyema cavities were surrounded by low-intensity rims, and two of them showed a signal intensity different from that of necrotic tumors. Scintigraphy revealed increased uptake of gallium in all cases. Ultrasonography was useful for biopsy guidance. Every radiologist should know this entity in observation of chest radiographs obtained in patients with chronic empyema, and further radiologic assessment and aggressive biopsy are recommended if malignancy is suspected.

A Case of Squamous Cell Carcinoma Developed in Chronic Tuberculous Empyema Following Therapeutic Extrapleural Pneumothorax

“…An enhanced mass adjacent to empyema or nodular pleural thickening on a chest CT scan is suggestive of malignancy complicated with chronic empyema [14]. Watanabe et al reported two types of tumor fi ndings in the literature [7], mass formation type and scattered foci type, and radiological fi ndings in this case were compatible with the former.…”

Metastatic Lung Cancer Presenting as Thoracic Empyema in an Old Patient

“…However, the management of lung cancer complicated with a thoracic empyema in an older patient remains a challenge. A few cases of adenocarcinoma-associated empyema have been reported previously, but the origin of the adenocarcinoma remains unknown (7)(8)(9). Some chest radiographic findings, such as new air-fluid levels, destruction of bone, soft tissue bulges in the chest wall and increased dens- ity in the thoracic cavity, can be suspicious of malignancy (7,9).…”

“…A few cases of adenocarcinoma-associated empyema have been reported previously, but the origin of the adenocarcinoma remains unknown (7)(8)(9). Some chest radiographic findings, such as new air-fluid levels, destruction of bone, soft tissue bulges in the chest wall and increased dens- ity in the thoracic cavity, can be suspicious of malignancy (7,9). Further studies of the pleural fluid should be conducted, including erythrocyte/leukocyte counts, gram staining, cultures, and cytological examinations (5).…”

Pyothorax-Associated Lymphoma Diagnosed by Preoperative Pleural Effusion Aspiration Cytology

“…5 Nakatsuka et al 6 reported that 88% of PALs showed a diffuse proliferation of large B-cell type cells, making it difficult to distinguish PAL from other diseases by radiographic findings. A biopsy is needed to confirm the diagnosis.…”