Split pleura sign. Enhanced CT of the chest shows a low attenuating pleural fluid collection juxtaposed between the enhancing visceral (white arrow) and parietal (black arrow) pleura, confirming an empyema in this patient. Source Signs in Thoracic Imaging Journal of Thoracic Imaging 21(1):76-90, March 2006.
Separation and enhancement of the visceral and parietal pleural layers on CT (Fig. 22) is considered strong evidence of empyema.3,61 Normally, individual pleural layers are not discernable as discrete structures.3 Empyemic fluid fills the pleural space, resulting in thickening and enhancement of the pleura with a denotable separation.3,61
The coronally reformatted image of the lung parenchyma has been outlined with the visceral pleura, (pink) the pleural fluid in the pleural space, (orange) and the parietal pleura (green). Note how at end expiration the parietal pleura in the costophrenic sulcus extends beyond the lung margin so that the visceral pleura is absent in the costophrenic sulcus and there are two layers of parietal pleura facing each other. During inspiration the lung expands into this space.
Courtesy of: Ashley Davidoff, M.D.
Mesothelioma
This combination of images is from a patient with mesothelioma associated with asbestos related disease. . Note the thickened pleura (green in b) the complex the associated effusion (orange in b). The lung is collapsed under the aggressive tumor. The right atrium is compressed by the tumor. Image c is an autopsy specimen of this patient showing the fibrous rind of tumor (yellow surrounding the lung (brown color) (e) and mediastinal structures magnified in d. Image e shows the external component of the mesothelioma with impressions of the ribs and image f shows the histology of the tumor charactarized by small and monotonous nuclii reminiscent of an epithelioid mesothelioma Ashley Davidoff MD TheCommonVein.net 32640c01L01.8CTscan in the coronal and axial planes in this patient with mesothelioma shows dense pleural surrounding the right hemithorax, with decrease in size of the right hemithorax (top row) compressive atelectasis of the middle lobe, (middle row) invasion into the pericardium and pericardial fat and small complex effusion with split pleura sign and thickened pleura (lower row) . Ashley Davidoff MD TheCommonVein.net pleura mesothelioma 0028c01
The coronally reformatted image of the lung parenchyma has been outlined with the visceral pleura, (pink) the pleural fluid in the pleural space, (orange) and the parietal pleura (green). Note how at end expiration the parietal pleura in the costophrenic sulcus extends beyond the lung margin so that the visceral pleura is absent in the costophrenic sulcus and there are two layers of parietal pleura facing each other. During inspiration the lung expands into this space.
