Pleural Lymphatic Metastases

Pleural thickening may be caused solely by tumor in lymphatics or by a combination of lymphatic tumor, fibrosis, and perhaps edema. Although the term "subpleural thickening" is often used for this type of deposit, the tumor actually resides in the lymphatics of the pleura. Lymphatics are absent from the alveolar parenchyma. By HRCT parenchymal subpleural nodules may be difficult to distinguish from pleural lymphatic carcinomatosis.

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Pleural Lymphatic Carcinomatosis without Fibrosis

Here, lymphatics are distended with tumor. The large lymphatic at the left is in an interlobular septum, but the others are in the pleura. Note that there is no fibrosis of the pleural interstitium.

Find the tumor-filled lymphatic in the interlobular septum.

Find 3 tumor-filled lymphatics confined to the pleura.

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Pleural Lymphatic Carcinomatosis with Fibrosis

Here, fibrosis of the pleura accompanies the tumor in lymphatics. Note the chronic inflammatory cells at the border of the lung and pleura.

Find 3 lymphatics distended by tumor.

 

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Interlobular septal lymphatic distended by tumor

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Pleural lymphatic distended by tumor

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Pleural lymphatic filled with tumor

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