Localized Fibrous Tumor of the Pleura Mimicking a Pleural Effusion

This article is an answer to the Case – Patient with Chest Pain, Dyspnea, Palpitations and Cough

A posteroanterior and lateral Chest radiograph on admission to the hospital showed homogeneous and well-circumscribed opacification occupying the lower two-thirds of the left hemithorax. The initial diagnosis of pleural effusion was made, and a difficult pleurocentesis yielded a little amount (20 ml) of bloody fluid.

Then, a chest CT (see image below) was performed and the initial diagnosis was modified at that moment, according to the CT findings. The interest of this case is the presentation of this Solitary Fibrous Tumour.

Chest CT

In the emergency room the patient was diagnosed of pleural effusion according to the symptoms, physical examination, chest x-ray and CT. The diagnosis of a septated pleural effusion was made by a non-experienced radiology resident on guard.

Next day several experienced radiologists found clues for a different diagnosis: CT showed branching linear structures of enhancement within the lesion –consistent with intralesional blood vessels (image below) – and the CT numbers were similar to those of soft-tissue attenuation. Then, the possibility of a pleural tumour was taken into account.

Chest CT showing branching linear structures consistent with intralesional blood vessels
Chest CT showing branching linear structures consistent with intralesional blood vessels

After a diagnostic pleuroscopy, the patient underwent a thoracotomy, and a large lobulated gray-white mass with firm consistency occupying a great portion of the left hemithorax was encountered. The histologic diagnosis was of localized fibrous tumor of the pleura.


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