Lee Dongjun, Son Min Ji, Yoo Seung Min, Lee Hwa Yeon, White Charles S
Military Service in Korean Army, Hongcheon 25117, Korea.
Department of Radiology, CHA University Bundang Medical Center, Seongnam 13497, Korea.
Diagnostics (Basel). 2020 Dec 3;10(12):1041. doi: 10.3390/diagnostics10121041.
This study investigated the potential role of paracardiac fat stranding (FS) interspersed with multiple fluid collections (FC) as a clue to differentiate between pleural tuberculosis (pleural TB) and malignant pleural effusion (MPE). The authors retrospectively analyzed chest computed tomography (CT) findings of 428 patients, 351 with pleural TB and 77 with MPE, focusing on the paracardiac fat, and level of pleural adenosine deaminase (ADA) and blood C-reactive protein (CRP). Two radiologists independently evaluated the chest CT findings regarding the paracardiac fat pad ipsilateral to the effusion, including FS, FC, phlegmonous appearance (a combination of the FS and multiple FC), and the presence of lymph node enlargement (>1 cm in short axis diameter). There were significant differences between patients with pleural TB and those with MPE with respect to the prevalence of phlegmonous appearance in the ipsilateral paracardiac fat (47.6% and 10.4%, < 0.001, OR = 7.8; 95% CI 3.7-16.8) and paracardiac lymph node enlargement (1.4% and 19.5%, < 0.001, OR = 0.06; 95% CI 0.02-0.2) on CT. In contrast, there was no difference in the prevalence of isolated FS or multiple FC within the ipsilateral paracardiac fat between the two groups. Median pleural ADA and serum CRP level were higher in patients with pleural TB accompanied by phlegmonous appearance in paracardiac fat compared to those without that appearance (ADA: median 104 IU/L versus 90 IU/L, < 0.001; CRP: 6.5 mg/dL versus 4.2 mg/dL, < 0.001). In conclusion, phlegmonous appearance in the ipsilateral paracardiac fat without paracardiac lymph node enlargement on chest CT favors a diagnosis of pleural TB over MPE.
本研究调查了伴有多个液性渗出灶（FC）的心脏旁脂肪条索状影（FS）在鉴别胸膜结核（pleural TB）和恶性胸腔积液（MPE）方面的潜在作用。作者回顾性分析了428例患者的胸部计算机断层扫描（CT）结果，其中351例为胸膜结核，77例为恶性胸腔积液，重点关注心脏旁脂肪、胸膜腺苷脱氨酶（ADA）水平和血液C反应蛋白（CRP）。两名放射科医生独立评估了与积液同侧的心脏旁脂肪垫的胸部CT表现，包括FS、FC、蜂窝状表现（FS和多个FC的组合）以及淋巴结肿大（短轴直径>1 cm）的存在情况。胸膜结核患者和恶性胸腔积液患者在同侧心脏旁脂肪的蜂窝状表现发生率（47.6%和10.4%，<0.001，OR = 7.8；95% CI 3.7 - 16.8）和心脏旁淋巴结肿大发生率（1.4%和19.5%，<0.001，OR = 0.06；95% CI 0.02 - 0.2）方面存在显著差异。相比之下，两组同侧心脏旁脂肪内孤立FS或多个FC的发生率没有差异。与无心脏旁脂肪蜂窝状表现的胸膜结核患者相比，伴有心脏旁脂肪蜂窝状表现的胸膜结核患者的胸膜ADA中位数和血清CRP水平更高（ADA：中位数104 IU/L对90 IU/L，<0.001；CRP：6.5 mg/dL对4.2 mg/dL，<0.001）。总之，胸部CT显示同侧心脏旁脂肪出现蜂窝状表现且无心脏旁淋巴结肿大，相较于恶性胸腔积液，更支持胸膜结核的诊断。
