PMC6482239_01
Gross findings of the pericardial sac (A) and epicardium (B) during surgery. Multiple white nodules (arrows in A) and plaques (arrowheads in B) were identified on the surface of the thickened pericardial sac and the epicardium, respectively.
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F1
During surgery, in addition to serosanguinous pleural effusion; multiple white, minute-to-small nodules and plaque lesions were observed on the inner surface of the pericardial sac (Figure 1).
Ultrasonographic evaluation of disseminated neoplastic lesions on the pleura. Small nodules of 1-1.3 mm size on the surface of the pleura, exhibiting homogeneous low echogenicity inside with a hypoechoic structure, were identified, which had not been noted at the early stage of the disease, via detailed ultrasonographic examination using a high frequency linear probe (A, arrows). The adjacent normal pleurae were delineated as finely hyperechoic linear structures (B, arrowheads). The nodules gradually increased in size and number on the parietal pleura (C, arrows) as well as the visceral pleura and diaphragm (D, arrows). Arrowheads, parietal pleura; TW, thoracic wall; PE, pleural effusion; DP, diaphragm; PL, lung; LIV, liver. Scale bar = 0.5 cm.
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F2
Follow-up chest ultrasonography revealed recurrent pleural effusion on Day 38, and successfully detected multiple minute nodules 1.0-1.3 mm in size, which were early disseminated lesions on the parietal pleura, on Day 101 (Figure 2A). The adjacent intact pleurae were delineated as fine, hyperechoic linear structures (Figure 2B). At the advanced stage, the nodules coalesced with each other and covered the surface of the pleura, leading to pleural thickening (Figure 2C). Scanning other regions of the chest wall identified similar nodules on the diaphragm (Figure 2D) and the parietal pleura of other ventral regions.