The objective of our article was to describe the spectrum and frequency of pleural abnormalities on CT in patients with
lymphangioleiomyomatosis (
LAM) and the pleural findings associated with different types of
pleurodesis (
talc, mechanical, and chemical) performed to treat the complications of
pleural disease in these patients.
MATERIALS AND METHODS: Two hundred fifty-eight patients with
LAM underwent CT of the chest. Pleural abnormalities assessed included pleural thickening, presence of a pleural mass, areas of high attenuation, effusion, and
pneumothorax. In patients who had had
pleurodesis, the CT findings were correlated with the type of procedure performed.
RESULTS: One hundred thirty-three (52%) of 258 patients had
pleurodesis (unilateral, 68/133; bilateral, 65/133). Pleural abnormalities were more common in patients who had
pleurodesis (101/133, 76%) than in those who had not (47/125, 38%) and were more prevalent on the operated side than on the unoperated side of those 68 patients who had unilateral
pleurodesis. The frequencies of findings for the group without
pleurodesis versus the group with
pleurodesis were pleural thickening (26% vs 65%), effusion (10% vs 13%), loculated effusion (2.4% vs 11%),
pneumothorax (1.6% vs 10%), areas of high attenuation (1.6% vs 23%), and mass (0.8% vs 14%), respectively. Areas of high attenuation in the pleura were present in all types of
pleurodesis (mechanical, 8%; chemical, 13%;
talc, 40%) and in two patients who had had repeated thoracentesis or pleurectomy. Pleural masses were present in patients who had had all types of
pleurodesis (mechanical, 10%; chemical, 9%;
talc, 24%) and in one patient who had had thoracentesis and
thoracostomy; the masses commonly enhanced and did not change in size over time.
CONCLUSION: Pleural abnormalities are common in patients with
LAM as complications of the disease itself and as sequelae of
pleurodesis and other pleura manipulations.
Pneumothorax and
pleural effusion result from the underlying pathophysiology of
LAM, whereas areas of high attenuation and masses develop after all types of
pleurodesis and other manipulations of the pleura (i.e., thoracentesis,
thoracostomy).