ROUNDED ATELECTASIS - ANOTHER PULMONARY P SEUDOTUMOR

Rounded atelectasis or Blesovsky's syndrome (also called pleuroma, fol ded lung or shrinking pleuritis with atelectasis) is the association o f plaque-like pleural fibrosis with a folding visceral pleura and nodu lar atelectasis of the underlying lung. It can mimic a peripheral lung tumor or a mesothelioma. Radiography and computed tomography (CT) sho w a characteristic opacity with a comet-tail sign. The pathogenesis in some of the cases is considered to be secondary to pleural effusions and in others to a contraction of a focus of pleural fibrosis, not ass ociated with effusion. In many cases, there was a history of asbestos exposure. We report the case of a 44 year-old, man who had smoked and worked with materials containing asbestos. He referred thoracic pain o f 6 months duration and dyspnea. An X-ray of the chest (Fig. 1, 2) and a CT scan (Fig. 3) revealed a round peripheral mass in the left lower lobe. A fine needle aspiration biopsy of the lung was performed revea ling clusters of large atypical cells with abundant cytoplasm. A thora cotomy was decided upon and no frozen section was requested. Gross exa mination of the resected lobe (Fig. 4) demonstrated a 2.5 cm white, ir regular, firm and retracting pleural plaque. On sectioning, a peculiar folding of the visceral pleura delimited by anthracotic pigmentation was noted below the fibrotic plaque. The folding extended perpendicula rly deep into the parenchyma. It was possible to separate the folding and liberate the underlying parenchyma, which was firm, fibrotic and a telectatic. No tumor was found anywhere within the lobe. In many of th e published reports, surgery was deemed unnecesary considering the typ ical radiographic images. However, we consider that histological confi rmation is necessary to rule out a lung or a pleural tumor. We are awa re of, at least, one report in which a typical comet-tail image was pr esent in a case of an adenocarcinoma of the lung. After reviewing the slides, the atypical cells we found in the FNA were interpreted as irr itated mesothelial cells. However, we were puzzled that no mesothelial cells were found among the pleural infoldings. Reexamination of the x -rays after the final results demonstrated a rather typical comet-tail image that was previously overlooked.