CT appearances of pleural infection: analysis of the Second Multi-centre Intra-pleural Sepsis Trial (MIST 2) cohort. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Franklin, J.; Talwar, A.; Addala, D.; Helm, E.J.; Benamore, R.; Rahman, N.M.; Gleeson, F.V.
• Is Part Of: Clinical radiology. Volume 76:Issue 6(2021)
• Page Start: 436
• Page End: 442
• Publication Date: 2021-06
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2020.12.017
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIM: To determine the prevalence of pleural abnormalities and describe the computed tomography (CT) features observed in a well-characterised population of patients with pleural infection. MATERIALS AND METHODS: A retrospective study of a subgroup of patients from the Second Multi-centre Intra-pleural Sepsis Trial (MIST 2) trial was carried out. Patients were diagnosed with pleural infection on robust clinical criteria. CT examinations were assessed by three observers independently for the presence of predefined features. Planned subgroup comparisons of patients with and without evidence of parenchymal infection were performed. RESULTS: Eighty-one patients were included. Parietal pleural thickening and enhancement were seen in 98.7% of patients. Visceral pleural changes were observed in most, including several previously undescribed features. Consolidation was observed in 61.7% of patients and there was a significant association of parenchymal consolidation with CT evidence of small airways infection ( p< 0.001) and visceral pleural thickening and enhancement ( p< 0.05). Features of parenchymal infection were absent in one third of patients. CONCLUSION: This study provides a comprehensive account of the parietal pleural, visceral pleural, and parenchymal changes of pleural infection on CT. Parenchymal infection is absent in a significant proportion of patients with pleural infection, suggesting that a pneumonic process may not be necessary for the development of pleural infection. Highlights: Retrospective study in a well characterized patient cohort presenting with empyema. Detailed description of radiological characteristics of pleural infection on CT. Pleural infection does not always arise from a pneumonic process.