The parietal and visceral pleura are specialized membranes which are highly efficient in keeping the pleural space essentially dry and free of protein and particulate matter. Radiology has played a pivotal role in the understanding of pleural diseases because radiography and, more recently, computed tomography (CT), sonography, and magnetic resonance imaging (MRI) have allowed in vivo visualization of abnormalities. In addition, these newer modalities have been invaluable in guiding diagnostic and therapeutic measures. Cross-sectional imaging techniques, particularly CT, are frequently of assistance in determining whether tube thoracostomy or other surgical measures are indicated, and when these procedures should be performed. The application of newer imaging modalities in expediting the management of pleural diseases is emphasized. The anatomy, histology, and physiology of the pleura, in both normal and disease states, are also reviewed.

Diagnostic Imaging↗

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CT of the airways.

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Bronchi↗

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Radiology of the pleural fissures: an historical perspective.

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Barium Sulfate↗

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Angulated needle placement in CT-guided percutaneous needle biopsy of the thorax.

Computed tomography (CT)-guided percutaneous needle biopsy is often necessary to evaluate small intrathoracic lesions. Not infrequently, an overlying structure such as a rib or vessel precludes insertion of the biopsy needle within the CT slice containing the lesion. Insertion and angulation of the needle at a site within an adjacent CT slice is then required. In order to determine the optimal skin-entry site and degree of angulation for biopsy needle insertion, we analyzed the geometric relationship between lesion depth, needle length, and needle angulation.

Biopsy, Needle↗

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Pneumothorax during fluoroscopic biopsy: effect on nodule depth.

Transthoracic needle aspiration biopsy of lung nodules is often performed under fluoroscopic guidance after measurement of lesion depth on preliminary computed tomography (CT) scans is obtained. We evaluated the change in depth of nodules in 10 patients in whom pneumothorax developed during CT-guided biopsy. We observed that nodule depth changed by an amount equal to the size of the pneumothorax. Awareness of the potential effect of pneumothorax on lesion depth should be helpful in reducing the likelihood of false-negative results with CT-assisted fluoroscopic biopsy when only single-plane fluoroscopy is available.

Biopsy, Needle↗