|
1
|
Yamamoto N, Onoda K. Thoracolithiasis: a rare pearl earring-like lesion. Indian J Thorac Cardiovasc Surg 2024; 40:497-499. [PMID: 38919193 PMCID: PMC11194228 DOI: 10.1007/s12055-024-01698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 06/27/2024] Open
Abstract
Thoracolithiasis has been reported as one or more free-mobile bodies, and this free mobility in the pleural cavities could be a clue to the diagnosis. Here, we report a rare case of immobile thoracolithiasis anchored to the pleural fat like a pearl earring.
Collapse
Affiliation(s)
- Naoki Yamamoto
- Department of Cardiovascular Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, Wakayama 647-0072 Japan
| | - Koji Onoda
- Department of Cardiovascular Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, Wakayama 647-0072 Japan
| |
Collapse
|
|
2
|
Hsu FC, Huang TW, Pu TW. Formation of a rare curve-shaped thoracolith documented on serial chest computed tomography images: A case report. World J Clin Cases 2023; 11:2329-2335. [PMID: 37122524 PMCID: PMC10131032 DOI: 10.12998/wjcc.v11.i10.2329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/11/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Thoracolithiasis is a rare benign condition that manifests with one or more small nodules in the pleural cavity. In most cases, it is asymptomatic and found incidentally on chest imaging or during thoracic surgery. The thoracolithiasis formation process is rarely documented. Herein, we present a case of a rare, large, curve-shaped thoracolith, the formation of which was documented on serial computed tomography (CT) images.
CASE SUMMARY A 46-year-old male patient who denied any prior systemic disease was evaluated due to intermittent right-sided lateral chest pain lasting for a year. Chest radiography and CT revealed a circumscribed calcified nodule measuring 3.5 mm in the right lower lung lobe. Nodule biopsy revealed fungal infection, which was treated with antifungal medication. After 2 years of follow-up, the patient developed intermittent chest discomfort caused by pleural adhesions, and underwent video-assisted thoracic surgery with pneumolysis. Postoperatively, he developed empyema, which fully resolved with antibiotic therapy. Thereafter, he was followed up at the outpatient clinic and underwent chest CT twice per year. Over time, we observed thickening of the right distal pleura near the lower posterior mediastinum, and several sporadic calcified nodules with gradually increasing intensity, which eventually merged into a single calcified curve-shaped thoracolith measuring approximately 9 cm in length during the 5-year follow-up.
CONCLUSION This study documented the formation of a rare thoracolith shape observed for the first time.
Collapse
Affiliation(s)
- Fu-Chieh Hsu
- Department of Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
| |
Collapse
|
|
3
|
Thoracolithiasis: A Case of Pleural Pearls. J Bronchology Interv Pulmonol 2019; 26:e31-e32. [PMID: 31233473 DOI: 10.1097/lbr.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
4
|
Kang N, Choi Y, Im Y, Choe J, Kim J, Han J, Kim TJ, Kim H. A rare case of numerous thoracolithiasis with chest discomfort. Respir Med Case Rep 2018; 25:264-266. [PMID: 30338224 PMCID: PMC6186962 DOI: 10.1016/j.rmcr.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022] Open
Abstract
Thoracolithiasis is a rare benign condition with mobile free bodies in the pleural cavity. It is asymptomatic and mostly found incidentally. Up to our knowledge there is no report of symptomatic numerous thoracolithiasis. We report a very rare case of thoracolithiasis in a 36-year-old female with chest discomfort. Images from computed tomography presented a chain of small non-enhancing nodules in the left hemi-diaphragmatic pleura. Exploratory thoracoscopy was performed and twenty-five mobile pearl like thoracolithiasis were discovered. Histopathology showed extensive necrotic fatty tissue at its center surrounded by fibrosis. The patient was symptom-free after the surgical removal of numerous thoracolithiasis, suggesting thoracolithiasis was associated with chest discomfort.
Collapse
Affiliation(s)
- Noeul Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeonseok Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joungho Han
- Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Jeong Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
|
5
|
Gayer G. Thoracolithiasis-Computed Tomography Findings of Intrapleural Loose Bodies. Semin Ultrasound CT MR 2017; 38:634-640. [PMID: 29179903 DOI: 10.1053/j.sult.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thoracoliths are rare benign intrapleural loose bodies, often containing calcification, that are mobile in the pleural cavity. The presence of these intrapleural nodules is referred to as thoracolithiasis. The exact etiology of thoracoliths is unknown, but they presumably result from a prior episode of mediastinal (epipericardial) fat necrosis. Thoracoliths are usually asymptomatic and incidentally encountered on computed tomography. However, they sometimes pose diagnostic challenges, as a thoracolith may be located within a pleural fissure, and is then indistinguishable from a pulmonary nodule. In addition, migration and rotation of thoracoliths within the pleural space observed on serial computed tomography studies has been reported to raise concern that these might be neoplastic lesions, leading to their surgical removal. Awareness of this benign condition is important in order to avoid unnecessary invasive procedures.
Collapse
Affiliation(s)
- Gabriela Gayer
- Department of Radiology, Stanford University Hospitals and Clinics, Stanford, CA; Department of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel, affiliated with the Tel Aviv University, Israel.
| |
Collapse
|
|
6
|
Abstract
PURPOSE To review thin-section CT findings of thoracolithiasis. MATERIALS AND METHODS Thirty-three thin-section CT scans of 9 patients with thoracolithiasis diagnosed between 2008 and 2016 were reviewed for the location, shape, longest diameter, and calcification of each freely mobile nodule (thoracolith) and for the presence of coexisting abnormalities. RESULTS The mean age of 9 patients (5 women) was 65.8 years (SD 14.9; range 37-83 years). Eight were > 50 years of age. Three patients had two thoracoliths, and the remaining 6 patients had one. Thoracoliths were in the left (n = 9) or right (n = 3) pleural cavity, with most in the lower pleural cavity. Nine thoracoliths were found to be larger at follow-up. The median diameters of the 12 thoracoliths were 4.9 mm (range 2.1-10.6 mm) and 6.2 mm (range 3.6-11.0 mm) on the initial and latest follow-up CT scans, respectively. Concomitant old granulomatous disease (n = 6) and diffuse systemic sclerosis-related interstitial lung disease (n = 2) were noted. CONCLUSION Thoracolithiasis can manifest as one or two small calcified nodules. It tends to occur in the left lower pleural cavity, occur in a patient aged > 50 years, be larger on follow-up, and coincide with other diseases.
Collapse
|
|
7
|
Kim Y, Shim SS, Chun EM, Won TH, Park S. A Pleural Loose Body Mimicking a Pleural Tumor: A Case Report. Korean J Radiol 2015; 16:1163-5. [PMID: 26355378 PMCID: PMC4559788 DOI: 10.3348/kjr.2015.16.5.1163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/10/2015] [Indexed: 11/15/2022] Open
Abstract
We present a rare case of a pleural loose body, thought to be a pedunculated pleural tumor, found incidentally in a 58-year-old female. Computed tomography showed a non-enhancing mass, which migrated along the mediastinum and paravertebral area. Thoracoscopic surgery revealed a 4 cm, soap-like mass that was found to be a fibrin body consisting of hyalinized collagen histopathologically. Mobility and the lack of contrast enhancement of a pleural mass are important clues to diagnosing this benign condition.
Collapse
Affiliation(s)
- Yookyung Kim
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul 07985, Korea
| | - Sung Shine Shim
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul 07985, Korea
| | - Eun Mi Chun
- Division of Pulmonology and Critical Care Medicine in Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul 07985, Korea
| | - Tae Hee Won
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Ewha Womans University, Seoul 07985, Korea
| | - Sanghui Park
- Department of Pathology, School of Medicine, Ewha Womans University, Seoul 07985, Korea
| |
Collapse
|
|
8
|
Hejna P, Laco J. Thoracolithiasis: a unique autopsy finding. Forensic Sci Med Pathol 2014; 10:457-60. [PMID: 24570035 DOI: 10.1007/s12024-014-9542-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Petr Hejna
- Department of Forensic Medicine, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, 500 05, Hradec Kralove, Czech Republic,
| | | |
Collapse
|
|
9
|
Peungjesada S, Gupta P, Mottershaw AM. Thoracolithiasis: a case report. Clin Imaging 2012; 36:228-30. [PMID: 22542384 DOI: 10.1016/j.clinimag.2011.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 08/27/2011] [Accepted: 08/30/2011] [Indexed: 11/17/2022]
Abstract
We present a rare case of incidentally found mobile thoracolithiasis in a 76-year-old cirrhotic patient on serial computed tomography scans performed before and after transarterial chemoembolization for hepatocellular carcinoma. Mobility and calcification are the important clue to diagnosing this benign condition and avoiding unnecessary surgery.
Collapse
Affiliation(s)
- Silanath Peungjesada
- Radiology Service, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, TX 75216, USA.
| | | | | |
Collapse
|
|
10
|
Rawstorne E, Muzaffar J, Hawari M, Naidu P, Steyn R. Multiple thoracolithiasis: An incidental finding. J Surg Case Rep 2012; 2012:1. [PMID: 24960759 PMCID: PMC3649582 DOI: 10.1093/jscr/2012.8.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Thoracoliths are rare benign intrapleural fibrotic structures with a necrotic fat core. There are 19 previous reported cases in the literature. This case report presents for the first time, a patient with two thoracoliths within the same hemithorax. Both lesions were identified incidentally in the left hemithorax by computed tomography and remained in the same position on repeat imaging. The lesions were removed by a video-assisted thoracic surgery approach. Histology revealed a 20mm and a 14mm lesion, with a fibrotic dense collagen shell surrounding a non-viable necrotic fat core. This case demonstrates that thoracolithiasis is a rare differential diagnosis for incidental multiple non-mobile lesions within the thorax.
Collapse
Affiliation(s)
| | | | - M Hawari
- Birmingham Heartlands Hospital, UK
| | - P Naidu
- Birmingham Heartlands Hospital, UK
| | - R Steyn
- Birmingham Heartlands Hospital, UK
| |
Collapse
|
|
11
|
Komatsu T, Sowa T, Fujinaga T. A case of thoracolithiasis diagnosed thoracoscopically. Int J Surg Case Rep 2012; 3:415-6. [PMID: 22705577 DOI: 10.1016/j.ijscr.2012.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Thoracolithiasis is quite rare with only 18 cases reported in the literature. PRESENTATION OF CASE The 65-year-old female was referred to us for the abnormality on the chest X-ray. The serial computed tomographic (CT) scans showed a mobile calcified nodule of about 10mm in diameter. Exploratory thoracoscopy was performed. A 15mm pearl-like pleural stone was removed with uneventful postoperative course. DISCUSSION Thoracolithiasis is very rare, and its etiology as well as its epidemiology still remains to be unclear. Preoperative diagnosis is always difficult. However, specific radiological findings could let us recognize the probability of that lesion and avoid unnecessary major operation. CONCLUSION Thoracolithiasis should never be overlooked as a differential diagnosis in a pulmonary calcified nodule.
Collapse
Affiliation(s)
- Teruya Komatsu
- Department of General Thoracic Surgery, Nagara Medical Center, Gifu, Japan
| | | | | |
Collapse
|
|
12
|
Kinoshita F, Saida Y, Okajima Y, Honda S, Sato T, Hayashibe A, Hiramatsu S. Thoracolithiasis. J Thorac Imaging 2010; 25:64-7. [DOI: 10.1097/rti.0b013e3181a4ba03] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
13
|
Abstract
A 66-year-old man was referred for evaluation of a "pulmonary nodule" found on a routine chest radiograph. Computed tomography detected a subpleural nodule of 13 mm in diameter between the upper and lower lobes of the right thoracic cavity. Follow-up chest radiograph and computed tomography after 9 months revealed migration and rotation along the right major fissure. Suspecting a pleural tumor, video-assisted thoracic surgery was performed, and a glossy white nodule of 13 x 11 mm in diameter was removed with forceps. Histopathologically, the nodule consisted of adipose and fatty necrotic tissue surrounded by hyalinized fibrous tissue. The diagnosis was thoracolithiasis.
Collapse
|
|
14
|
Strzelczyk J, Holloway BJ, Pernicano PG, Kelly AM. Rolling stones in the pleural space: thoracoliths on CT, and a review of the literature. Clin Radiol 2009; 64:100-4. [PMID: 19070704 DOI: 10.1016/j.crad.2008.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 09/10/2008] [Accepted: 09/11/2008] [Indexed: 11/18/2022]
Affiliation(s)
- J Strzelczyk
- Department of Radiology, Division of Cardiothoracic Imaging, University of Michigan, Ann Arbor, MI 48109-0030, USA
| | | | | | | |
Collapse
|
|
15
|
Abstract
A case is reported of broncholithiasis in a 29-year-old female factory worker presenting with cough and lithoptysis. Broncholithiasis is a rare disorder characterized by calcified perihilar and mediastinal lymph nodes eroding into the tracheobronchial tree. Although cough, hemoptysis, lithoptysis, pneumonia and bronchoesophageal fistula formation have been reported, broncholithiasis may also result in potentially life-threatening conditions such as airway obstruction from endobronchial polypoid granulation masses, and massive hemorrhage from an aorto-tracheal fistula or erosion of a pulmonary artery branch.
Collapse
Affiliation(s)
- Kathryn Craig
- Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | | |
Collapse
|
|
16
|
Kosaka S, Kondo N, Sakaguchi H, Kitano T, Harada T, Nakayama K. Thoracolithiasis. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:318-21. [PMID: 10860288 DOI: 10.1007/bf03218148] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Thoracolithiasis without any history of chest traumas or interventions is pathologically rare, with only 9 cases including our 2, reported thus far in the literature. Case 1: A 76-year-old man admitted to our hospital had an abnormal shadow in chest radiography that gradually enlarged. Serum carcinoembrionic antigen was slightly elevated during follow-up. A milky white tumor 1.5 cm in diameter with many projections was found in the thoracic cavity and removed by thoracoscopy. Histopathological examination showed the tumor to consist of fibrous tissue with fatty necrosis at the core. Case 2: A 54-year-old woman admitted to our hospital had an abnormal shadow in chest screening radiography in 1998. Transbronchial biopsy showed this shadow to be lung adenocarcinoma. A small trigonal pyramid-shaped milky white nodule 5 mm in diameter was found in the thorax during lobectomy for lung cancer. Histopathological examination showed this nodule also to consist of fibrous tissue with fatty necrosis.
Collapse
Affiliation(s)
- S Kosaka
- Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | | | | | | | | | | |
Collapse
|
|
17
|
Doud JR, Bakhos M, McCabe MA, Garrity ER. Bronchial dehiscence associated with a large broncholith in a lung transplant recipient. Chest 1992; 102:1273-4. [PMID: 1395782 DOI: 10.1378/chest.102.4.1273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 63-year-old man who underwent single lung transplantation for advanced emphysema had a postoperative course complicated by asymptomatic bronchial dehiscence associated with a large broncholith. The stone eventually caused airway obstruction requiring partial fragmentation and incomplete extrication. We suggest that calcified nodes of significant size be removed at the time of surgery in the lung transplant recipient.
Collapse
Affiliation(s)
- J R Doud
- Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, Ill
| | | | | | | |
Collapse
|
|
18
|
Shin MS, Ho KJ. Broncholithiasis: its detection by computed tomography in patients with recurrent hemoptysis of unknown etiology. THE JOURNAL OF COMPUTED TOMOGRAPHY 1983; 7:189-93. [PMID: 6872567 DOI: 10.1016/0149-936x(83)90045-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Broncholithiasis is often not diagnosed by conventional roentgenography and fiberoptic bronchoscopy. Demonstrated here and three such cases of "recurrent hemoptysis of unknown etiology,". The broncholith in each case was clearly demonstrated only by the thoracic computed tomography (CT). We stress that CT is an extremely useful modality in the diagnosis of broncholithiasis and that the true incidence of broncholithiasis could be greater than was previously believed.
Collapse
|
|
19
|
Abstract
Broncholithiasis, associated most frequently with tuberculosis and histoplasmosis, usually presents with acute onset of cough and hemoptysis. Visible stones are coughed up in fewer cases than was previously believed. The disease may be accompanied by obstructive symptoms, bronchiectasis, and occasional fistula formation into either the esophagus or the aorta. The prognosis of these patients is generally excellent; however, a significant number require surgery because of persistent symptoms or a complication of the disease.
Collapse
|