Pleural rindJ94.1

A pleural rind is a fibrous swelling of the pleura which leads to a retraction of the thoracic wall and to a localized bondage of the lung. This more or less restricts or even cancels out the normally existing breath-dependent expansion.

The pleural rind corresponds to a defect healing. It should not be confused with the hyaline pleural callosity, which can occur, for example, after exposure to asbestos.

In connection with pleural ridges, a primary or secondary pleural effusion is often also found.

A pleural rind is a fibrous swelling of the pleura which leads to a retraction of the thoracic wall and to a localized bondage of the lung. This more or less restricts or even cancels out the normally existing breath-dependent expansion.

The pleural rind corresponds to a defect healing. It should not be confused with the hyaline pleural callosity, which can occur, for example, after exposure to asbestos.

In connection with pleural ridges, a primary or secondary pleural effusion is often also found.

Primarily caused by the following diseases:

• Empyema (only in stage 3 rind formation occurs due to proliferation of fibroblasts).
• hematothorax
• chronic pneumothorax

But also a mesothelioma, a pleural carcinosis, a primary lung carcinoma, tuberculosis, Z.n thoracic surgery, etc. can cause a Verschwartung.

• performance constraints
• tracheal cough
• Dyspnoea, especially under stress
• some patients complain of a feeling of armor around the chest

vocal freemity:

Attenuated on the affected side

Percussion:

Here you can find a light damping

Lung function

There is a restrictive disorder. This is not so much due to pleural adhesions as to the impaired function of the diaphragm.

Transthoracic Sonography

The rind appears weakly echogenic in ultrasound.

The fresh rind can sometimes be echo-free and then easily confused with an effusion. This can be easily differentiated, as no respiratory lung displacement can be detected when both pleural leaves are grown together (in contrast to the effusion).

Occasionally, connective tissue changes and calcifications are also found, which then lead to an increase in echogenicity.

In ultrasound one can easily distinguish between liquid and solid formation.

However, the pleural rind cannot be reliably distinguished from a malignant change.

Colour duplex sonography:

In colour Doppler ultrasound, the rind resulting from an inflammatory etiology is particularly visible. This is often more vascularized.

The occasional cyst-like inclusions can also be easily distinguished from vessels.

Perfusion scintigraphy

It very accurately represents the functional pulmonary failure. This is of particular importance preoperatively or for a possible expert opinion.

X-ray

In the x-ray image, the verschwartung appears as a shadowing. Older, calcified rinds usually do not require further diagnosis.

CT

A CT should be performed if the diagnosis is unclear, especially to exclude a malignancy.

• Pleural mesothelioma
• Pleural carcinosis

Initially, at least in the early stages of the disease, a conservative therapy attempt should be made with an oral corticosteroid (e.g. 20 mg methylprednisolon/d for 2 months).

In addition, repeated pleurolysis (streptokinase/urokinase) is recommended.

If, however, the patient still has significant exercise dyspnea afterwards and a severe restrictive dysfunction of the lung function is evident which cannot be caused by other factors, surgical decoration should be performed.

1. Dietrich CF et al (2006) Ultrasound course S 348
2. Gerok W et al.(2007) Die Innere Medizin - Reference work for the medical specialist S 476
3. Herold G et al (2017) Internal Medicine S 330, 431
4. Konietzko N et al (1995) Diseases of the lung S 91, 92
5. Kroegel C et al (2014) Clinical Pneumology - The Reference Work for Clinics and Practices S 513-514
6. Mathis G et al (2001) Image Atlas of Lung and Pleural Sonography S 29, 30