Enhancement or calcification: Solution by spectral CT : Lung India

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Case Letter

Enhancement or calcification

Solution by spectral CT

Canan, Arzu

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doi: 10.4103/lungindia.lungindia_183_22
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A young patient with history of recurrent idiopathic pneumothorax and prior pleurodesis presented to emergency department for pleuritic chest pain. Chest computed tomography angiography (CTA) revealed no pulmonary embolism, pleural effusion or recurrent pneumothorax. However, multiple bilateral, hyperdense pleural nodules with posterior predominance were identified. It was not clear if hyperattenuation was secondary to contrast enhancement or calcification. Since the study was performed with spectral computed tomography (CT), virtual non-contrast reconstructions were obtained, which demonstrated persistent hyperattenuation indicating the presence of calcification/high-density material rather than contrast enhancement [Figure 1]. The diagnosis of post-talc pleurodesis changes was made based on the imaging findings and past medical history.

Figure 1:
Subsequent axial images from chest CTA (left column) demonstrate multiple bilateral, hyperdense pleural nodules (arrows) with apical and posterior predominance. Corresponding virtual non-contrast reconstruction (right column) images show persistent high attenuation of the nodules, confirming the presence of calcification rather than enhancement. The contrast within the mediastinal vasculature and heart was also homogenously eliminated, except the contrast in superior vena cava due to higher contrast amount. CTA = computed tomography angiography

Although post-talc pleurodesis CT findings are well described on non-contrast studies, it may be difficult to differentiate the enhancing pleural lesions from calcified/hyperdense pleural plaques on contrast-enhanced studies.[12] Virtual non-contrast reconstructions that are available on spectral CT can be useful in identification of calcification without risk of additional radiation dose.

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1. Narayanaswamy S, Kamath S, Williams M CT appearances of talc pleurodesis Clin Radiol 2007 62 233–7
2. Sonoda A, Jeudy J, White CS, Kligerman SJ, Nitta N, Lempel J, et al Pleurodesis:Indications and radiologic appearance Jpn J Radiol 2015 33 241–5
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