Uncategorized

• What is it:
  • A pleural tag refers to:
    • A fibrotic band or soft tissue strand
    • that extends from the pleura into the adjacent lung parenchyma.
  • These tags often indicate:
    • Pleural-lung interaction caused by:
      • Neoplastic,
      • Inflammatory, or
      • Fibrotic processes.
  • The clinical significance varies and depends on:
    • Associated imaging findings, and
    • Whether the process is benign or malignant.
• Etymology:
  • Derived from the Latin word tagare (to fasten), describing the connective strand attaching the pleura to the lung.
• AKA:
  • Pleural tether, Pleural band.
• How does it appear on each relevant imaging modality:
  • Chest X-ray:
    • May appear as:
      • Subtle linear opacities,
      • Extending from the pleura into the lung,
      • Often difficult to detect.
  • Chest CT:
    • Parts:
      • Fibrous or soft tissue bands,
      • Extending from the pleura into the adjacent lung parenchyma.
    • Size:
      • Thin, elongated structures,
      • Varying thickness depending on the cause.
    • Shape:
      • Linear,
      • Curvilinear, or
      • Irregular bands.
    • Position:
      • Adjacent to pleural-based lesions, or
      • Within areas of pleural thickening.
    • Character:
      • Soft tissue density,
      • Often associated with pleural thickening or retraction.
    • Time:
      • Stable in benign cases,
      • Progressing or changing with malignancy or active inflammation.
  • MRI:
    • May reveal:
      • The nature of the tag,
      • Differentiating fibrosis from tumor extension.
• These findings reflect:
  • Benign processes:
    • Inflammatory fibrosis,
    • Organizing pneumonia,
    • Post-surgical or post-traumatic changes.
  • Malignant processes:
    • Peripheral lung cancer with pleural involvement,
    • Mesothelioma, or
    • Metastatic disease causing pleural retraction.
• Differential diagnosis:
  • Benign:
    • Post-inflammatory or post-traumatic pleural thickening.
    • Organizing pneumonia.
    • Post-surgical changes (e.g., after thoracic surgery or pleurodesis).
  • Malignant:
    • Peripheral lung cancer or mesothelioma with pleural involvement.
    • Pleural metastases causing tethering.
  • Fibrotic processes:
    • Rounded atelectasis with adjacent pleural tethering.
    • Asbestos-related pleural fibrosis.
• Recommendations:
  • Evaluate with Chest CT for detailed characterization of the pleural tag, associated pleural thickening, and adjacent lung abnormalities.
  • Correlate findings with clinical history and risk factors, such as:
    • Smoking,
    • Asbestos exposure, or
    • Prior malignancy.
  • Consider PET-CT or biopsy if the pleural tag is associated with:
    • A suspicious lesion, or
    • Features suggesting malignancy.
  • Monitor benign-appearing pleural tags with serial imaging.
• Key points and pearls:
  • Pleural tags often reflect pleural-lung interaction caused by neoplastic, inflammatory, or fibrotic processes.
  • Stability over time on imaging suggests a benign process, while progressive change raises suspicion for malignancy.
  • Malignant pleural tags often accompany:
    • Irregular pleural thickening, or
    • Retraction of adjacent lung tissue.
  • PET-CT is valuable for assessing metabolic activity and distinguishing benign from malignant processes.