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Mobile Thoracolithiasis

Published:February 15, 2018DOI:https://doi.org/10.1016/j.amjmed.2018.01.025
      A 68-year-old woman with a history of follicular lymphoma who underwent serial computed tomography of the chest was found to have an 11-mm calcified nodule, repeatedly described as granuloma, that was noted to change position within the right pleural space (Figure). Given the movement, a thoracolithiasis was identified. Thoracolithiasis is a rare, benign condition with an estimated incidence of <0.1%. It is defined as one or more ovoid bodies with smooth margins with or without calcification that are freely mobile within the pleural cavity, with a size range from 5 to 15 mm. Thoracoliths may be formed from necrotic pleural tissue, a lipoma, an inactive granuloma from pulmonary tuberculosis or other granulomatous process, or an aggregation of macrophages.
      • Suwatanapongched T.
      • Nitiwarangkul C.
      Thin-section CT findings of thoracolithiasis.
      A migratory or spilled gallstone post laparoscopic surgery can mimic a thoracolith.
      • Suwatanapongched T.
      • Nitiwarangkul C.
      Thin-section CT findings of thoracolithiasis.
      Most cases are found incidentally either through imaging studies or during surgery. In an asymptomatic patient, calcification, mobility, and an inferior intrapleural location on serial images are dependable imaging findings for the diagnosis without need for surgical removal. Surgical removal may be necessary to objectively diagnose these stones through pathologic confirmation, but treatment is neither needed nor recommended.
      Figure
      FigureCalcified thoracolith: Multiple axial computed tomography images of the chest without contrast at 3 different dates. Top: Mediastinal windows. Middle row: Lung windows. Bottom: Bone windows. Note an 8-mm calcific body (arrows) located along the posterior peri-diaphragmatic pleura in the study dated 8/18/2011(A-C). In the images (D-F) dated 9/2/2014, the focus is now seen along the anterior peri-diaphragmatic pleura, and by 3/9/2015 (G-I), it outlines the right inferior parietal, indicating that it is floating within the pleural space.
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      Reference

        • Suwatanapongched T.
        • Nitiwarangkul C.
        Thin-section CT findings of thoracolithiasis.
        Jpn J Radiol. 2017; 35: 355-356