V.c
Pleural thickening
Typically bilateral. Can predominate on one side. May encase the lung(s). Usually more prominent in the lower lung regions. Pleural effusion may predate or accompany pleural thickening. On imaging, notably CT, rounded atelectasis (the 'folded lung: Vo) can be present in intimate contact with the areas of thickened pleura. Pulmonary shadowing may be present en face areas of pleural thickening (so-called 'pleuropulmonary fibrosis'), an elective complication of ergot drugs. Pericardial thickening can also be present. Pneumothorax is a distinctive complication of alkylant- (CCNU, cyclophosphamide)-induced pleural thickening also named pleuroparenchymal fibroelastosis (Ix, Vp). Ergots can produce retroperitonal fibrosis with ureteral compression and consequent hydronephrosis. Pleural thickening can sometimes be tracer (18F-DG)-avid on PET-scan imaging
Causative drugs
30
Radiation therapy to the chest
I.a
I - Interstitial/parenchymal lung disease
I.a - Pneumonitis (ILD), acute and/or severe (may cause ARDS) I.b I - Interstitial/parenchymal lung disease
I.b - Pneumonitis (ILD) I.c I - Interstitial/parenchymal lung disease
I.c - Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia) I.d I - Interstitial/parenchymal lung disease
I.d - Organizing pneumonia pattern (an area or areas of consolidation on imaging) I.g I - Interstitial/parenchymal lung disease
I.g - Pulmonary fibrosis I.h I - Interstitial/parenchymal lung disease
I.h - Subclinical pulmonary infiltrates/ILD I.k I - Interstitial/parenchymal lung disease
I.k - Lung nodule or nodules I.l I - Interstitial/parenchymal lung disease
I.l - Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf) I.o I - Interstitial/parenchymal lung disease
I.o - Focal/localized area of pneumonitis/fibrosis I.v I - Interstitial/parenchymal lung disease
I.v - Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence I.x I - Interstitial/parenchymal lung disease
I.x - Pleuroparenchymal fibroelastosis (PPFE) I.y I - Interstitial/parenchymal lung disease
I.y - Progression, acceleration or exacerbation of preexisting ILD/fibrosis II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury III.h III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.h - Major/massive hemoptysis IV.h IV - Airway involvement
IV.h - Large airway necrosis IV.m IV - Airway involvement
IV.m - Bronchial stenosis/stricture V.a V - Pleural and/or pericardial involvement
V.a - Pleural effusion (uni- or bilateral) (can accompany DI-LDs) V.c V - Pleural and/or pericardial involvement
V.c - Pleural thickening V.f V - Pleural and/or pericardial involvement
V.f - Pneumothorax V.h V - Pleural and/or pericardial involvement
V.h - Chylothorax V.k V - Pleural and/or pericardial involvement
V.k - Pleural calcifications VI.c VI - Pulmonary vasculopathies
VI.c - Pulmonary veno-occlusive disease VI.x VI - Pulmonary vasculopathies
VI.x - Pulmonary lymphangiectasis VII.d VII - Mediastinal involvement
VII.d - Fibrosing mediastinitis VIII.c VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.c - Upper airway obstruction other than angioedema or hematoma VIII.r VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.r - Tracheal/large airway necrosis, chondronecrosis, perforation VIII.t VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.t - Vocal cord paresis/paralysis VIII.ab VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.ab - Airway (e.g. tracheoesophageal) fistula IX.j IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.j - Phrenic nerve injury - Hemi- or bilateral diaphragmatic paralysis XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XI.h XI - Miscellaneous
XI.h - Esophageal pathology (erosion, ulcer, tear, rupture, fistula) XI.i XI - Miscellaneous
XI.i - Esophageal toxicity XI.j XI - Miscellaneous
XI.j - Esophageal dysmotility XI.w XI - Miscellaneous
XI.w - Cavitation/necrosis of lung tumor or metastases XI.ag XI - Miscellaneous
XI.ag - Vertebral compression fracture XII.b XII - Cardiovascular involvement / toxicity
XII.b - Valvular heart disease and/or dysfunction XII.k XII - Cardiovascular involvement / toxicity
XII.k - Constrictive pericarditis - Pericardial thickening XII.o XII - Cardiovascular involvement / toxicity
XII.o - Coronary artery disease (subacute, chronic) XII.s XII - Cardiovascular involvement / toxicity
XII.s - Heart block (bundle branch- or AV-) XIII.e XIII - Neoplastic conditions
XIII.e - Breast cancer XV.c XV - Pathology
XV.c - Path: Organizing pneumonia (OP/BOOP) pattern (see also Id) XV.f XV - Pathology
XV.f - Path: Diffuse alveolar damage (DAD-pattern) (see also IL) XV.h XV - Pathology
XV.h - Path: NSIP-fibrotic pattern XV.i XV - Pathology
XV.i - Path: Pneumocyte atypia (reactive epithelial cells) (a.k.a. the "Napoleon Hat" sign) XV.bm XV - Pathology
XV.bm - Path: Diffuse lymphangiectasis XVI.bl XVI - Imaging
XVI.bl - Imaging: An area or areas of avid tracer uptake in the lung/chest on 18F-PET scan XVII.e XVII - Infections & related conditions
XVII.e - Pneumocystis jiroveci pneumonia XVII.af XVII - Infections & related conditions
XVII.af - Reactivation of a prior pulmonary infection (TB, melioidosis) XIX.a XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.a - BAL: An excess proportion of lymphocytes
I.a - Pneumonitis (ILD), acute and/or severe (may cause ARDS) I.b I - Interstitial/parenchymal lung disease
I.b - Pneumonitis (ILD) I.c I - Interstitial/parenchymal lung disease
I.c - Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia) I.d I - Interstitial/parenchymal lung disease
I.d - Organizing pneumonia pattern (an area or areas of consolidation on imaging) I.g I - Interstitial/parenchymal lung disease
I.g - Pulmonary fibrosis I.h I - Interstitial/parenchymal lung disease
I.h - Subclinical pulmonary infiltrates/ILD I.k I - Interstitial/parenchymal lung disease
I.k - Lung nodule or nodules I.l I - Interstitial/parenchymal lung disease
I.l - Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf) I.o I - Interstitial/parenchymal lung disease
I.o - Focal/localized area of pneumonitis/fibrosis I.v I - Interstitial/parenchymal lung disease
I.v - Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence I.x I - Interstitial/parenchymal lung disease
I.x - Pleuroparenchymal fibroelastosis (PPFE) I.y I - Interstitial/parenchymal lung disease
I.y - Progression, acceleration or exacerbation of preexisting ILD/fibrosis II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury III.h III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.h - Major/massive hemoptysis IV.h IV - Airway involvement
IV.h - Large airway necrosis IV.m IV - Airway involvement
IV.m - Bronchial stenosis/stricture V.a V - Pleural and/or pericardial involvement
V.a - Pleural effusion (uni- or bilateral) (can accompany DI-LDs) V.c V - Pleural and/or pericardial involvement
V.c - Pleural thickening V.f V - Pleural and/or pericardial involvement
V.f - Pneumothorax V.h V - Pleural and/or pericardial involvement
V.h - Chylothorax V.k V - Pleural and/or pericardial involvement
V.k - Pleural calcifications VI.c VI - Pulmonary vasculopathies
VI.c - Pulmonary veno-occlusive disease VI.x VI - Pulmonary vasculopathies
VI.x - Pulmonary lymphangiectasis VII.d VII - Mediastinal involvement
VII.d - Fibrosing mediastinitis VIII.c VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.c - Upper airway obstruction other than angioedema or hematoma VIII.r VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.r - Tracheal/large airway necrosis, chondronecrosis, perforation VIII.t VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.t - Vocal cord paresis/paralysis VIII.ab VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.ab - Airway (e.g. tracheoesophageal) fistula IX.j IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.j - Phrenic nerve injury - Hemi- or bilateral diaphragmatic paralysis XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XI.h XI - Miscellaneous
XI.h - Esophageal pathology (erosion, ulcer, tear, rupture, fistula) XI.i XI - Miscellaneous
XI.i - Esophageal toxicity XI.j XI - Miscellaneous
XI.j - Esophageal dysmotility XI.w XI - Miscellaneous
XI.w - Cavitation/necrosis of lung tumor or metastases XI.ag XI - Miscellaneous
XI.ag - Vertebral compression fracture XII.b XII - Cardiovascular involvement / toxicity
XII.b - Valvular heart disease and/or dysfunction XII.k XII - Cardiovascular involvement / toxicity
XII.k - Constrictive pericarditis - Pericardial thickening XII.o XII - Cardiovascular involvement / toxicity
XII.o - Coronary artery disease (subacute, chronic) XII.s XII - Cardiovascular involvement / toxicity
XII.s - Heart block (bundle branch- or AV-) XIII.e XIII - Neoplastic conditions
XIII.e - Breast cancer XV.c XV - Pathology
XV.c - Path: Organizing pneumonia (OP/BOOP) pattern (see also Id) XV.f XV - Pathology
XV.f - Path: Diffuse alveolar damage (DAD-pattern) (see also IL) XV.h XV - Pathology
XV.h - Path: NSIP-fibrotic pattern XV.i XV - Pathology
XV.i - Path: Pneumocyte atypia (reactive epithelial cells) (a.k.a. the "Napoleon Hat" sign) XV.bm XV - Pathology
XV.bm - Path: Diffuse lymphangiectasis XVI.bl XVI - Imaging
XVI.bl - Imaging: An area or areas of avid tracer uptake in the lung/chest on 18F-PET scan XVII.e XVII - Infections & related conditions
XVII.e - Pneumocystis jiroveci pneumonia XVII.af XVII - Infections & related conditions
XVII.af - Reactivation of a prior pulmonary infection (TB, melioidosis) XIX.a XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.a - BAL: An excess proportion of lymphocytes
3
Status post-thoracic/cardiovascular surgery
I.y
I - Interstitial/parenchymal lung disease
I.y - Progression, acceleration or exacerbation of preexisting ILD/fibrosis V.a V - Pleural and/or pericardial involvement
V.a - Pleural effusion (uni- or bilateral) (can accompany DI-LDs) V.c V - Pleural and/or pericardial involvement
V.c - Pleural thickening V.f V - Pleural and/or pericardial involvement
V.f - Pneumothorax V.h V - Pleural and/or pericardial involvement
V.h - Chylothorax VII.i VII - Mediastinal involvement
VII.i - Mediastinitis X.k X - Systemic/Distant conditions, syndromes and reactions
X.k - Sarcoid-like granulomatosis (endo-/extrathoracic) XII.k XII - Cardiovascular involvement / toxicity
XII.k - Constrictive pericarditis - Pericardial thickening XVIII.e XVIII - Distinctive patterns - 'Eye-catchers'
XVIII.e - Eye-catcher: Multiple radiolucent balls
I.y - Progression, acceleration or exacerbation of preexisting ILD/fibrosis V.a V - Pleural and/or pericardial involvement
V.a - Pleural effusion (uni- or bilateral) (can accompany DI-LDs) V.c V - Pleural and/or pericardial involvement
V.c - Pleural thickening V.f V - Pleural and/or pericardial involvement
V.f - Pneumothorax V.h V - Pleural and/or pericardial involvement
V.h - Chylothorax VII.i VII - Mediastinal involvement
VII.i - Mediastinitis X.k X - Systemic/Distant conditions, syndromes and reactions
X.k - Sarcoid-like granulomatosis (endo-/extrathoracic) XII.k XII - Cardiovascular involvement / toxicity
XII.k - Constrictive pericarditis - Pericardial thickening XVIII.e XVIII - Distinctive patterns - 'Eye-catchers'
XVIII.e - Eye-catcher: Multiple radiolucent balls
2
Talc (inhaled, sniffed, i.v., intrapleural)
I.d
I - Interstitial/parenchymal lung disease
I.d - Organizing pneumonia pattern (an area or areas of consolidation on imaging) I.t I - Interstitial/parenchymal lung disease
I.t - Pneumoconiosis (silicosis, talcosis...) II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury II.f II - Pulmonary edema - Acute lung injury - ARDS
II.f - Hypoxemia, low oxygen saturation (may occur in isolation) IV.c IV - Airway involvement
IV.c - Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx) IV.i IV - Airway involvement
IV.i - Foreign body aspiration bronchiolitis IV.m IV - Airway involvement
IV.m - Bronchial stenosis/stricture V.c V - Pleural and/or pericardial involvement
V.c - Pleural thickening V.r V - Pleural and/or pericardial involvement
V.r - Pleural mass or masses VI.b VI - Pulmonary vasculopathies
VI.b - Pulmonary arterial hypertension VI.g VI - Pulmonary vasculopathies
VI.g - Foreign body pulmonary vasculopathy (Excipient lung disease) VII.f VII - Mediastinal involvement
VII.f - An enlarged or dense thymus VII.n VII - Mediastinal involvement
VII.n - Mediastinal talcoma X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XI.u XI - Miscellaneous
XI.u - Chest pressure/discomfort XV.e XV - Pathology
XV.e - Path: ILD with a granulomatous component (see also Im) XV.q XV - Pathology
XV.q - Path: Foreign body deposits/granulomatous reaction XV.s XV - Pathology
XV.s - Path: Pneumoconiosis (silicosis, talcosis, talcoma) XV.ag XV - Pathology
XV.ag - Path: Foreign body embolism, microangiopathy, vasculopathy XV.da XV - Pathology
XV.da - Path: Birefringent particles in lung tissue and/or cells XVI.w XVI - Imaging
XVI.w - Imaging: Lung nodule or nodules XVI.ae XVI - Imaging
XVI.ae - Imaging: A pattern similar to pneumoconiotic progressive massive fibrosis (PMF) XVI.bm XVI - Imaging
XVI.bm - Imaging: Avid pleural uptake on PET-scan XVIII.i XVIII - Distinctive patterns - 'Eye-catchers'
XVIII.i - Eye-catcher: Tracer-avid pleural area or areas on PET-CT XIX.k XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.k - BAL: Talc crystals in macrophages or lying free in BALF
I.d - Organizing pneumonia pattern (an area or areas of consolidation on imaging) I.t I - Interstitial/parenchymal lung disease
I.t - Pneumoconiosis (silicosis, talcosis...) II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury II.f II - Pulmonary edema - Acute lung injury - ARDS
II.f - Hypoxemia, low oxygen saturation (may occur in isolation) IV.c IV - Airway involvement
IV.c - Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx) IV.i IV - Airway involvement
IV.i - Foreign body aspiration bronchiolitis IV.m IV - Airway involvement
IV.m - Bronchial stenosis/stricture V.c V - Pleural and/or pericardial involvement
V.c - Pleural thickening V.r V - Pleural and/or pericardial involvement
V.r - Pleural mass or masses VI.b VI - Pulmonary vasculopathies
VI.b - Pulmonary arterial hypertension VI.g VI - Pulmonary vasculopathies
VI.g - Foreign body pulmonary vasculopathy (Excipient lung disease) VII.f VII - Mediastinal involvement
VII.f - An enlarged or dense thymus VII.n VII - Mediastinal involvement
VII.n - Mediastinal talcoma X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XI.u XI - Miscellaneous
XI.u - Chest pressure/discomfort XV.e XV - Pathology
XV.e - Path: ILD with a granulomatous component (see also Im) XV.q XV - Pathology
XV.q - Path: Foreign body deposits/granulomatous reaction XV.s XV - Pathology
XV.s - Path: Pneumoconiosis (silicosis, talcosis, talcoma) XV.ag XV - Pathology
XV.ag - Path: Foreign body embolism, microangiopathy, vasculopathy XV.da XV - Pathology
XV.da - Path: Birefringent particles in lung tissue and/or cells XVI.w XVI - Imaging
XVI.w - Imaging: Lung nodule or nodules XVI.ae XVI - Imaging
XVI.ae - Imaging: A pattern similar to pneumoconiotic progressive massive fibrosis (PMF) XVI.bm XVI - Imaging
XVI.bm - Imaging: Avid pleural uptake on PET-scan XVIII.i XVIII - Distinctive patterns - 'Eye-catchers'
XVIII.i - Eye-catcher: Tracer-avid pleural area or areas on PET-CT XIX.k XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.k - BAL: Talc crystals in macrophages or lying free in BALF
1
1