PMC3568019_01
Chest radiograph. A: Pleural based opacities in the right hemithorax at presentation. B: Marked improvements after 6 months of antituberculous chemotherapy. C: Further improvements another 6 months after the completion of chemotherapy.
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F1
A 26-year-old man with no subjective symptoms was referred to our hospital because of a chest radiographic abnormality in the right hemithorax on his chest X-ray (Figure 1A), which was incidentally found during a college health examination. Six months after the completion of chemotherapy, a chest radiograph showed further improvements in pleural based opacities relative to that taken just after chemotherapy (Figure 1B and C).
FDG PET image. A: Multiple lesions of intense FDG uptake in the right pleura at presentation. B: Clearly decreased positive signals after 6 months of antituberculous chemotherapy.
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F2
An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura (maximal standard uptake value (SUVmax) = 10.9) (Figure 2A and Figure 3A). Just after chemotherapy, a repeated FDG PET/CT scan revealed clearly decreased positive signals (SUVmax = 5.7) with marked improvements in pleural thickening (Figure 2B and Figure 3B).
FDG PET/CT scan. A: Extensive nodular thickening of the right pleura at presentation showing intense FDG uptake without distinct pleural effusion and parenchymal lung lesions. B: Marked improvements with decreased positive signals after 6 months of antituberculous chemotherapy.
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F3
An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura (maximal standard uptake value (SUVmax) = 10.9) (Figure 2A and Figure 3A). Just after chemotherapy, a repeated FDG PET/CT scan revealed clearly decreased positive signals (SUVmax = 5.7) with marked improvements in pleural thickening (Figure 2B and Figure 3B).
Pathological findings of pleural tissue. A: Caseous necrosis. B: Granulomatous inflammation.
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F4
Thoracoscopic biopsy of the pleural tissue revealed caseous necrosis and granulomatous inflammation (Figure 4), although acid-fast bacilli were not found in biopsy specimens.