Table 1 Characteristics of the patients Table 2 Grading of the extent of pleural effusion and thickness on CT findings

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1 Lung cancer, Carcinomatous pleuritis, CT examination, Loculation, Intrapleural instillation therapy

2 Table 1 Characteristics of the patients Table 2 Grading of the extent of pleural effusion and thickness on CT findings

654 表2の日胸疾会誌24(6), ごとく, 胸水量をCT所見上V0からV5まで, 胸膜の肥厚の状態をTOからT4までの各段階に分 1986. け, その模式図を図1に示した. VlとV2とは半月上に貯留した胸水の頂点が胸隔の厚さの1/2を越えるか否かで分けた.

3 654 表2の日胸疾会誌24(6), ごとく, 胸水量をCT所見上V0からV5まで, 胸膜の肥厚の状態をTOからT4までの各段階に分け, その模式図を図1に示した. VlとV2とは半月上に貯留した胸水の頂点が胸隔の厚さの1/2を越えるか否かで分けた. 大量の胸水を認めるもので, 肺に含気を残すものはV3, 肺に含気を残さないものはV4, の対側への変位を認めるものをV5と縦隔した. 胸膜の肥厚についてはT1, T2は各々胸膜の肥厚が一部(Tl)または全周に及ぶもの(T2)とした. 被包化は, 図1のごとく, 臓側胸膜と壁側胸膜との接点が鈍(round)なものとし, 臓側胸膜が肺に対して凹となっているものをT3, 凸となっているものをT4として区別した(但し両者の差は肥厚の程度の差というよりも, 被包化される胸水量の少ないものがT4へわれた). さらにCT上, loculation と進行するように思胸水中に明らかな隔壁形成を認めるか, または治療時に混入した空気が複数の鏡面を形成したり胸水中にtrapされた状態が見られたも Fig. 1 Schematic example of grading the extent of pleural effusion (Vl-V5), the thickness of the pleura (T3-T4) and loculation. のを多房化とした(図1, 結治療開始からCT撮厚との関係は図3A, 図2). 果影までの期間と胸水量, 胸膜肥 Bのごとくであった. 胸水量は, v0 v1 v2 v3 v4 v5 (A) prior n=34 after n= n=6 3-6 n m T0 T1 T2 T3 T4 (B) Fig. 2 The loculated pleural space. A) Without contrast medium. Multiple free air spaces were observed in pleural effusion. B) With i.p. instillation of contrast medium, The loculated pleural space was demonstrated more clearly. prior after n=34 n=29 n=6 m Fig. 3 Analysis of the CT findings concerning the period after the initial instillation. A) Volume of the pleural effusion. B) Thickness of the pleura. Both were liable to increase in proportion to the period of observation.

0 1 2 3-5 6-10 11- n=35 n=18 n=14 n=15 n=13 n=6 (A) Fig. 4 Analysis of the CT findings concerning the number of i. p. instillation therapy procedures. A) Volume of the pleural effusion.

4 n=35 n=18 n=14 n=15 n=13 n=6 (A) Fig. 4 Analysis of the CT findings concerning the number of i. p. instillation therapy procedures. A) Volume of the pleural effusion. B) Thickness of the pleura. Concerning the number of therapy, both had the same tendency in Fig n=35 n=18 n=14 n=15 n=13 n=6 Fig. 5 Analysis of the cases of loculated pleural space from the standpoint of the period of the observation. A) Incidence of the loculation. Loculation observed in approximately half (46. 4%) of the cases in which the observation period was less than 1 month and then the incidence gradually decreased with time. B) The observation period of 21 cases with loculated pleural effusion. In 13 cases, loculation developed within 1 month after the initiation of the local therapy. (B) n=21(%)

5 Table 3 Characteristics of the Patients with Loculated Pleural Space Hist: histology, Prim: primary site, Surv: survival time, Inst: i. p. instillation Adc: adenocarcinoma, Sqc: squamous cell carcinoma, Lcc: large cell carcinoma, RUL: right upper lobe, RML: right middle lobe, RLL: right lower lobe, LMBr: left main bronchus, LUL: left upper lobe, LLL: left lower lobe,?: (primary site)unknown.

n=21 (%) Fig. 6 Analysis of the cases of loculated pleural effusion from the standpoint of the number of i. p. instillations. A) Incidence of the loculation.

6 n=21 (%) Fig. 6 Analysis of the cases of loculated pleural effusion from the standpoint of the number of i. p. instillations. A) Incidence of the loculation. There was no clear relationship between the incidence and the number of i. p. instillations, but at least i. p. instillation seems to be a trigger for the biginning of loculation. B) The number of i. p, instillations in 21 cases of loculated pleural effusion. In 13 cases (61. 5%) only less than 3 instillations were performed.

7 1) Anderson, C. B., Philpott, G. W. & Ferguson, T. B.: The treatment of malignant pleural effusions. Cancer, 33: 916, Abstract CT Findings of 53 Cases of Carcinomatous Pleuritis -Loculation of the Pleural Space- Yasuki Fukuda, Takeshi Homma, Masayuki Nakata, Shuuichi Yoneda, Yukio Noguchi and Seiichi Yoshida Saitama Cancer Center, Saitama, 362 Japan To investigate the clinical course and the prognosis of carcinomatous pleuritis following local therapy, we studied 101 CT films of 53 cases of carcinomatous pleuritis complicated with primary lung cancer. The histological types of the 53 cases included 43 adenocarcinomas, 4 squamous cell carcinomas, 4 small cell carcinomas and 2 large cell carcinomas. The median survival time was 6 months after the initial i. p. instillation. The mean number of i. p. instillations was 6. 1 times, median was 3. Instillated drugs were adriamycin, OK-432, ACNU, Mitomycin, aclacinorubicin or others. In the cases failed in pleurodesis, thickening of the pleura, reaccumulation of the pleural effusion and the loculated pleural space were observed at CT examination.

8 The loculated pleural space was observed in 21 cases (39. 6%), and the loculation of 13 cases developed within 1 month after the initiation of the local therapy or with less than 3 times i. p. instillation. In 12 out of 13 cases, malignant cells remained or reappeared in pleural effusion in spite of local treatment after the loculation. There was no statistical significance between the mean survival time of cases with loculated pleural space (4 months) and that of cases without loculation (8 months). The i. p. instillation of sclerosing agents are accepted to be rational and useful in the treatment of malignant pleural effusion. On the other hand, the drug instillation seems to have the disadvantage of the development of the loculated pleural space in the early stage of the local therapy. The loculation of the pleural space not only made it difficult to remove the pleural effusion and to reexpand the lung, but also was one of the causes of refractry pleuritis. So, to minimize the development of loculation, it is suggested that local therapy should be begun as soon as possible after the detection of the pleural effusion with the aim of complete reinflation of the atelectatic lung and complete closure of the pleural space (pleurodesis).

Table 1. Numbers of Cancerous Pleurisy Cases According to Primary Site Table 2. Histological Type of Lung Carcinoma with Cancerous Pleurisy at Autopsy

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