eMedicine Specialties > Radiology > Chest
Localized Fibrous Tumor of the Pleura: Imaging
Updated: Aug 2, 2007
Radiography
Findings
In most patients, the lesion is detected as an incidental finding on chest radiographs.
- The lesion appears on the chest radiograph as a well-circumscribed, homogeneous soft-tissue mass that is related closely to the pleura.
- The lesion can arise anywhere along the pleura and can even be seen in the pulmonary fissures or along the mediastinal or diaphragmatic pleura.
- The margins with lung parenchyma are well defined in most patients.
- In 2% of patients, the lesion is somewhat ill defined; in 2% of patients, the lesion is completely obscured by pleural effusion.
- The angle with the chest wall or mediastinum is either acute or obtuse. The obtuse angle is seen more often in small lesions, indicating the pleural origin of the lesion.
- Large tumors may present as an opaque hemithorax.
- Pleural effusion was reported in 17% of patients, especially in patients with the malignant variant of LFTP.
Degree of Confidence
Chest radiographic findings are nonspecific; however, a change in the position of the lesion with respiration or gravity is particularly suggestive of a pedunculated LFTP.
False Positives/Negatives
The lesion may mimic a mass of parenchymal or mediastinal origin, and large lesions may simulate an elevated diaphragm.
Computed Tomography
Findings
- Typically, an LFTP appears as a smoothly marginated, soft-tissue – attenuating mass abutting the pleura, with a round or lobulated contour.
- Areas of low attenuation can be seen within the lesion, especially when it is large.
- Unlike other pleural lesions, the angle between the mass and the pleura is most often acute. However, it can be obtuse, especially in small masses.
- The lesion is usually 1.5-25 cm in size.
- A small, ipsilateral pleural effusion can be seen.
- The lesion displaces the adjacent mediastinum and lung parenchyma, resulting in atelectasis.
- On contrast-enhanced CT scans, the lesion enhances more than the soft tissue does, because of its rich vascularization. Nonenhancing areas within the mass are correlated with the presence of necrosis, hemorrhage, or degeneration.
- Calcification is not common, but it can be seen.
- The detection of a pedicle or a change in the lesion's position is suggestive of an LFTP.
- The malignant form of LFTP cannot be confidently differentiated from the benign form by imaging. However, malignant lesions are typically larger than 10 cm and are more likely to be associated with central necrosis and a large pleural effusion.
Degree of Confidence
Manifestations of LFTP on CT scans are usually not pathognomonic, although some CT findings are highly suggestive of the diagnosis.
False Positives/Negatives
Small lesions may mimic primary lung carcinoma; however, a localized fibrous tumor is not associated with metastases or lymphadenopathy.
Magnetic Resonance Imaging
Findings
- Spin-echo T1-weighted magnetic resonance images predominantly demonstrate low to intermediate signal intensity, and T2-weighted images depict low signal intensity. The low intensity is attributed to the presence of fibrous, hypocellular tissue.
- Foci of increased signal intensity can be seen on T2-weighted images. These foci correspond to the regions of decreased attenuation on CT scans and represent areas of necrosis, hemorrhage, or degeneration.
- Intense enhancement is seen on gadolinium-enhanced T1-weighted images.
Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have recently been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy. The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or magnetic resonance angiography scans. As of late December 2006, the Food and Drug Administration had received reports of 90 such cases. Worldwide, over 200 cases have been reported, according to the FDA. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on thewhites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.
Degree of Confidence
MRI machines can produce multiplanar images, and MRI has superior tissue characterization compared with that of CT scanning; therefore, MRI is helpful in evaluating an LFTP and in defining its pleural origin and extension. After excluding calcifications, the presence of low signal intensity on both T1- and T2-weighted images is highly suggestive of the fibrous nature of the lesion.
Ultrasonography
Findings
Ultrasonography plays no role in the diagnostic workup of pleural masses. In some patients, however, ultrasonography may be performed to evaluate a pleural effusion or to guide procedures. The fibrous tumor typically demonstrates homogeneous low echogenicity. Associated pleural effusion appears anechoic.
Nuclear Imaging
Findings
A case report described the potential use of a fluorodeoxyglucose–positron emission tomography (FDG-PET) scan to evaluate the possibility of malignancy in LFTP. In this report, a high FDG uptake (with a standardized uptake ratio [SUR] of 3.0) was noted in a portion of the mass that exhibited malignant features histopathologically.2 The article suggested that FDG-PET can be helpful to determine preoperatively the presence of malignancy in patients with LFTP, whose prognoses are usually difficult to predict.
Angiography
Findings
The mass demonstrates hypervascularity with tumoral vessels. Typically, no early venous drainage is seen. The arterial supply is usually derived from the aorta (segmental arteries) and, in some patients, from the internal mammary artery.
Degree of Confidence
The angiographic appearance of the LFTP lesion is nonspecific.
More on Localized Fibrous Tumor of the Pleura |
| Overview: Localized Fibrous Tumor of the Pleura |
 Imaging: Localized Fibrous Tumor of the Pleura |
| Follow-up: Localized Fibrous Tumor of the Pleura |
| Multimedia: Localized Fibrous Tumor of the Pleura |
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References
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Further Reading
Keywords
LFTP, benign mesothelioma, fibrous mesothelioma, localized mesothelioma, diffuse mesothelioma, malignant mesothelioma, subpleural fibroma, submesothelial fibroma, pleural fibroma, pleural fibromyxoma, solitary fibrous tumor, localized fibrous pleural tumor, lung tumor, pleural tumor, pleural neoplasm, lung cancer, diffuse pleural tumor, localized pleural tumor
