DOI: 10.1148/rg.272065034
Postoperative Imaging of Esophageal Cancer: What Chest Radiologists Need to Know1
Tae Jung Kim, MD,
Kyoung Ho Lee, MD,
Young Hoon Kim, MD,
Sook Whan Sung, MD,
Sanghoon Jheon, MD,
Suk-ki Cho, MD and
Kyung Won Lee, MD
1 From the Departments of Radiology (T.J.K., K.H.L., Y.H.K., K.W.L.) and Thoracic Surgery (S.W.S., S.J., S.-K.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea; and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.K., K.H.L., Y.H.K., K.W.L.). Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received March 20, 2006; revision requested May 31; final revision received September 20; accepted September 25. All authors have no financial relationships to disclose.
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Figure 1. Drawings illustrate transthoracic esophagectomy with a laparotomy and a right thoracotomy (Ivor Lewis procedure). In A, an upper abdominal incision (arrowhead) and a posterolateral thoracotomy (arrow) are made. In B, the esophagus and its adjacent structures are dissected en bloc. Lymph node dissection is also performed. Arrows indicate resection lines. In C and D, an anastomosis is created between the remaining esophagus and the gastric tube. Straight arrow indicates the pyloromyotomy, curved arrow indicates the intrathoracic (C) and cervical (D) anastomosis sites, arrowhead indicates the original cardioesophageal junction.
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Figure 2a. Routes of esophagogastric anastomosis after an Ivor Lewis procedure. Computed tomographic (CT) scans (5-mm section thickness) show the mobilized gastric tube (arrow) in the prevertebral space of the posterior mediastinum (a), its most common location; in the substernal space of the anterior mediastinum (b); and in the right paravertebral space (c).
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Figure 2b. Routes of esophagogastric anastomosis after an Ivor Lewis procedure. Computed tomographic (CT) scans (5-mm section thickness) show the mobilized gastric tube (arrow) in the prevertebral space of the posterior mediastinum (a), its most common location; in the substernal space of the anterior mediastinum (b); and in the right paravertebral space (c).
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Figure 2c. Routes of esophagogastric anastomosis after an Ivor Lewis procedure. Computed tomographic (CT) scans (5-mm section thickness) show the mobilized gastric tube (arrow) in the prevertebral space of the posterior mediastinum (a), its most common location; in the substernal space of the anterior mediastinum (b); and in the right paravertebral space (c).
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Figure 3a. Ivor Lewis procedure in a 68-year-old man with squamous cell carcinoma (SCC) of the middle thoracic esophagus. (a) Pre-operative CT scan (5-mm section thickness) shows diffuse circumferential esophageal wall thickening (arrow). (b) Barium esophagogram obtained 2 months after surgery shows intrathoracic anastomoses (arrows) at the level of the aortic arch.
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Figure 3b. Ivor Lewis procedure in a 68-year-old man with squamous cell carcinoma (SCC) of the middle thoracic esophagus. (a) Pre-operative CT scan (5-mm section thickness) shows diffuse circumferential esophageal wall thickening (arrow). (b) Barium esophagogram obtained 2 months after surgery shows intrathoracic anastomoses (arrows) at the level of the aortic arch.
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Figure 4a. McKeown procedure in a 64-year-old man with SCC of the upper thoracic esophagus. (a) CT scan (5-mm section thickness) obtained at the level of the thyroid gland 2 months after surgery shows a cervical esophagogastric anastomosis (arrow). (b) Barium esophagogram obtained 2 months after surgery shows the cervical anastomosis (arrow). Arrowheads indicate a small amount of barium aspirate in the left lower lobe.
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Figure 4b. McKeown procedure in a 64-year-old man with SCC of the upper thoracic esophagus. (a) CT scan (5-mm section thickness) obtained at the level of the thyroid gland 2 months after surgery shows a cervical esophagogastric anastomosis (arrow). (b) Barium esophagogram obtained 2 months after surgery shows the cervical anastomosis (arrow). Arrowheads indicate a small amount of barium aspirate in the left lower lobe.
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Figure 5. Drawings illustrate transthoracic esophagectomy with a left thoracoabdominal approach. In A, the posterior mediastinum and superior abdominal compartment are approached with a single incision through the left sixth intercostal space (arrow). In B, the esophagus and its adjacent structures are dissected en bloc. Lymph node dissection is also performed. Arrows indicate resection lines. In C, an anastomosis is created between the remaining esophagus and the gastric tube. Arrow indicates the original cardioesophageal junction.
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Figure 6a. Transthoracic esophagectomy with a left thoracoabdominal approach in a 66-year-old man with double primary cancer of the left lung and the lower esophagus. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the right inferior pulmonary vein shows an esophageal mass (arrow) and a 3-cm mass in the lingular segment of the upper lobe of the left lung (arrowhead). (b) Fluorodeoxyglucose (FDG) positron emission tomographic (PET) scan shows two separate hypermetabolic lesions, one in the lower esophagus (standardized uptake value [SUV] = 11.2) and one in the left upper lobe (SUV = 14.3). (c) Barium esophagogram obtained 2 months after surgery shows an intrathoracic anastomosis with focal narrowing (arrow), a finding that suggests an anastomotic stricture. Arrowheads indicate the surgical clips used for lymph node dissection of the lung cancer.
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Figure 6b. Transthoracic esophagectomy with a left thoracoabdominal approach in a 66-year-old man with double primary cancer of the left lung and the lower esophagus. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the right inferior pulmonary vein shows an esophageal mass (arrow) and a 3-cm mass in the lingular segment of the upper lobe of the left lung (arrowhead). (b) Fluorodeoxyglucose (FDG) positron emission tomographic (PET) scan shows two separate hypermetabolic lesions, one in the lower esophagus (standardized uptake value [SUV] = 11.2) and one in the left upper lobe (SUV = 14.3). (c) Barium esophagogram obtained 2 months after surgery shows an intrathoracic anastomosis with focal narrowing (arrow), a finding that suggests an anastomotic stricture. Arrowheads indicate the surgical clips used for lymph node dissection of the lung cancer.
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Figure 6c. Transthoracic esophagectomy with a left thoracoabdominal approach in a 66-year-old man with double primary cancer of the left lung and the lower esophagus. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the right inferior pulmonary vein shows an esophageal mass (arrow) and a 3-cm mass in the lingular segment of the upper lobe of the left lung (arrowhead). (b) Fluorodeoxyglucose (FDG) positron emission tomographic (PET) scan shows two separate hypermetabolic lesions, one in the lower esophagus (standardized uptake value [SUV] = 11.2) and one in the left upper lobe (SUV = 14.3). (c) Barium esophagogram obtained 2 months after surgery shows an intrathoracic anastomosis with focal narrowing (arrow), a finding that suggests an anastomotic stricture. Arrowheads indicate the surgical clips used for lymph node dissection of the lung cancer.
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Figure 7. Drawings illustrate transhiatal esophagectomy without a thoracotomy. In A, a cervical incision parallel to the anterior border of the left sternocleidomastoid muscle (arrowhead) and an upper abdominal incision (arrow) are made. In B, the esophagus is dissected transhiatally by the surgeon passing his or her hand through the widened hiatus. Combined circumferential dissection of the esophagus through both the cervical and abdominal wounds allows the esophagus to be completely mobilized. In C, the esophagus and its adjacent structures are dissected. Lymph node dissection is also performed. Arrows indicate resection lines. In D, anastomoses are created between the remaining esophagus and the gastric tube. Straight arrow indicates the pyloromyotomy, curved arrow indicates the intrathoracic anastomosis site, arrowhead indicates the original cardioesophageal junction.
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Figure 8a. Transhiatal esophagectomy with a cervical esophagogastrostomy in a 60-year-old woman with SCC. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the liver dome shows an esophageal mass (arrow). (b) Barium esophagogram obtained 3 months after surgery shows a cervical esophagogastric anastomosis (arrow).
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Figure 8b. Transhiatal esophagectomy with a cervical esophagogastrostomy in a 60-year-old woman with SCC. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the liver dome shows an esophageal mass (arrow). (b) Barium esophagogram obtained 3 months after surgery shows a cervical esophagogastric anastomosis (arrow).
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Figure 9. Contraindication for transhiatal esophagectomy due to tracheal invasion in a 56-year-old man with SCC of the upper thoracic esophagus. CT scan (5-mm section thickness) obtained at the level of the left innominate vein shows an upper esophageal mass with suspicious invasion of the trachea (arrow) and an aberrant left subclavian artery (arrowhead) from the right-sided aortic arch. Ivor Lewis esophagectomy revealed tumoral invasion of the trachea and left subclavian artery.
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Figure 10. Contraindication for transhiatal esophagectomy due to aortic invasion in a 60-year-old man with SCC of the lower thoracic esophagus. CT scan (5-mm section thickness) obtained at the level of the left atrium shows a large esophageal mass abutting the descending thoracic aorta, with a contact area of more than 90° (arrows). Ivor Lewis esophagectomy revealed a dense tumor adhesion to the aorta.
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Figure 11a. Bypass surgery (esophagocologastrostomy) in a 57-year-old man with esophageal obstruction due to lower esophageal cancer. The patient underwent palliative surgery for hepatic metastases. (a) Pre-operative CT scan (5-mm section thickness) obtained at the level of the left atrium shows a bulky obstructing mass (arrow) in the lower thoracic esophagus. (b) Postoperative barium esophagogram shows substernal right colon interposition between the esophagus and the stomach.
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Figure 11b. Bypass surgery (esophagocologastrostomy) in a 57-year-old man with esophageal obstruction due to lower esophageal cancer. The patient underwent palliative surgery for hepatic metastases. (a) Pre-operative CT scan (5-mm section thickness) obtained at the level of the left atrium shows a bulky obstructing mass (arrow) in the lower thoracic esophagus. (b) Postoperative barium esophagogram shows substernal right colon interposition between the esophagus and the stomach.
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Figure 12. Drawings illustrate thoracoscopic port placement for minimally invasive esophagectomy. In A, four thoracoscopic ports are introduced. The camera port (10 mm) is placed at the seventh intercostal space on the midaxillary line. A 10-mm port is placed at the eighth or ninth intercostal space 2 cm posterior to the posterior axillary line for the ultrasonic coagulating shears. Two additional ports are placed, one (5 mm) posterior to the tip of the scapula and one (10 mm) at the fourth intercostal space at the anterior axillary line for retraction of the lung and esophageal countertraction during dissection. Dotted line indicates the diaphragm. In B, five abdominal ports are placed on the anterior abdominal wall: one cut-down 10-mm port in the right side of the epigastrium and four 5-mm ports in the bilateral subcostal, left epigastric, and right flank locations. Long dotted line indicates the diaphragm, short dotted line indicates the position of the neck incision. In C, a pyloroplasty (arrowhead) is performed using ultrasonic shears, and the incision is closed transversely. Then, a gastric tube (arrow) is constructed by dividing the stomach starting at the distal lesser curve while preserving the right gastric vessels. In D, an anastomosis (arrow) is created between the esophagus and the gastric tube. The gastric tube is sutured using an end-to-end anastomosis stapler.
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Figure 13a. Jejunal interposition (pharyngojejunoesophagostomy with jejunal free graft) in a 51-year-old man with SCC of the cervical esophagus. (a) Pre-operative CT scan (5-mm section thickness) obtained at the level of the cricoid cartilage shows a mass (arrow) in the cervical esophagus. (b) Postoperative barium esophagogram shows anastomoses at the pharyngojejunostomy (arrowhead) and jejunoesophagostomy (arrow) sites. Note the normal valvular conniventus of the jejunum.
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Figure 13b. Jejunal interposition (pharyngojejunoesophagostomy with jejunal free graft) in a 51-year-old man with SCC of the cervical esophagus. (a) Pre-operative CT scan (5-mm section thickness) obtained at the level of the cricoid cartilage shows a mass (arrow) in the cervical esophagus. (b) Postoperative barium esophagogram shows anastomoses at the pharyngojejunostomy (arrowhead) and jejunoesophagostomy (arrow) sites. Note the normal valvular conniventus of the jejunum.
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Figure 14. Drawing illustrates the anatomic location of the recurrent laryngeal nerves (arrowheads) and their relationship to adjacent structures. Arrows indicate the vagus nerves. Note the lymph nodes along the recurrent laryngeal nerves. Accurate dissection of the recurrent laryngeal nerve lymph nodes and preservation of these nerves are important surgical issues.
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Figure 15a. Right recurrent laryngeal nerve lymph node metastasis in a 57-year-old man with SCC of the upper esophagus. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the thoracic inlet shows metastatic lymph nodes (arrow) in the right recurrent laryngeal nerve lymph node chain. (b) FDG PET scan shows two hypermetabolic lesions, one in the upper esophagus (SUV = 10.8) (arrow) and one in the right recurrent laryngeal nerve lymph node chain (SUV = 8.7) (arrowhead).
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Figure 15b. Right recurrent laryngeal nerve lymph node metastasis in a 57-year-old man with SCC of the upper esophagus. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the thoracic inlet shows metastatic lymph nodes (arrow) in the right recurrent laryngeal nerve lymph node chain. (b) FDG PET scan shows two hypermetabolic lesions, one in the upper esophagus (SUV = 10.8) (arrow) and one in the right recurrent laryngeal nerve lymph node chain (SUV = 8.7) (arrowhead).
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Figure 16a. Acute respiratory distress syndrome in a 71-year-old man with middle thoracic esophageal cancer. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained at the level of the right main pulmonary artery 7 days after surgery shows bilateral diffuse ground-glass attenuation (arrowheads) and pleural effusions (arrows). The patient’s condition improved after steroid pulse therapy. (b) Frontal radiograph also demonstrates bilateral ground-glass opacity and a large amount of right pleural effusion.
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Figure 16b. Acute respiratory distress syndrome in a 71-year-old man with middle thoracic esophageal cancer. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained at the level of the right main pulmonary artery 7 days after surgery shows bilateral diffuse ground-glass attenuation (arrowheads) and pleural effusions (arrows). The patient’s condition improved after steroid pulse therapy. (b) Frontal radiograph also demonstrates bilateral ground-glass opacity and a large amount of right pleural effusion.
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Figure 17. Intrathoracic leak and mediastinal abscess due to anastomotic leak in a 60-year-old man with adenocarcinoma of the esophagogastric junction. The patient had undergone an Ivor Lewis procedure. CT scan obtained at the liver dome shows a fluid collection (arrow) in the posterior mediastinal space. Note the air bubbles within the abscess cavity. Primary closure of the stomach and reinforcement with diaphragmatic muscle were performed immediately.
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Figure 18a. Esophagopleural fistula and empyema in a 61-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained at the level of the aortic arch 15 days after surgery shows a fistula (arrowheads) between the gastric tube and the right pleural space. Note the fluid collection with pleural enhancement and thickening, findings that suggest empyema. (b) Gastrograffin fistulogram through the thoracotomy site shows a fistulous tract (arrowheads) between the pleural space and the stomach (arrow). The patient was treated with placement of a chest tube through the fistulous tract.
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Figure 18b. Esophagopleural fistula and empyema in a 61-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained at the level of the aortic arch 15 days after surgery shows a fistula (arrowheads) between the gastric tube and the right pleural space. Note the fluid collection with pleural enhancement and thickening, findings that suggest empyema. (b) Gastrograffin fistulogram through the thoracotomy site shows a fistulous tract (arrowheads) between the pleural space and the stomach (arrow). The patient was treated with placement of a chest tube through the fistulous tract.
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Figure 19a. Esophagocutaneous fistula in a 55-year-old man with SCC of the upper thoracic esophagus. The patient had undergone a McKeown procedure. (a) CT scan (5-mm section thickness) obtained at the level of the thyroid gland 7 days after surgery shows an esophagocutaneous fistula (arrowhead). (b) Barium esophagogram shows a leak at the cervical anastomosis site (arrowheads). The leakage was successfully managed conservatively.
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Figure 19b. Esophagocutaneous fistula in a 55-year-old man with SCC of the upper thoracic esophagus. The patient had undergone a McKeown procedure. (a) CT scan (5-mm section thickness) obtained at the level of the thyroid gland 7 days after surgery shows an esophagocutaneous fistula (arrowhead). (b) Barium esophagogram shows a leak at the cervical anastomosis site (arrowheads). The leakage was successfully managed conservatively.
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Figure 20a. Anastomotic stricture in a 69-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) Barium esophagogram obtained 3 months after surgery shows eccentric narrowing at the anastomosis site (arrow) with proximal esophageal dilatation. (b) Esophagogram shows dilatation of the anastomotic stricture.
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Figure 20b. Anastomotic stricture in a 69-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) Barium esophagogram obtained 3 months after surgery shows eccentric narrowing at the anastomosis site (arrow) with proximal esophageal dilatation. (b) Esophagogram shows dilatation of the anastomotic stricture.
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Figure 21a. Delayed emptying and intrathoracic redundancy. (a) Delayed gastric emptying in a 60-year-old man with SCC of the middle thoracic esophagus. The patient had undergone palliative esophagocologastrostomy for esophageal obstruction. Chest radiograph shows a distended gastric tube with a large air-fluid level (arrow), findings that suggest delayed gastric emptying. (b) Drawing illustrates the mechanism of delayed emptying due to intrathoracic redundancy after esophagocologastrostomy. Dotted lines indicate the kinking points.
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Figure 21b. Delayed emptying and intrathoracic redundancy. (a) Delayed gastric emptying in a 60-year-old man with SCC of the middle thoracic esophagus. The patient had undergone palliative esophagocologastrostomy for esophageal obstruction. Chest radiograph shows a distended gastric tube with a large air-fluid level (arrow), findings that suggest delayed gastric emptying. (b) Drawing illustrates the mechanism of delayed emptying due to intrathoracic redundancy after esophagocologastrostomy. Dotted lines indicate the kinking points.
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Figure 22a. Locoregional recurrence in a 72-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) Initial follow-up CT scan (5-mm section thickness) obtained at the level of the thoracic inlet 3 months after surgery shows a round, 4-mm lymph node (arrow) in the right recurrent laryngeal nerve lymph node chain. (b, c) Follow-up CT scans (5-mm section thickness) obtained at the level of the thoracic inlet (b) and bronchus intermedius (c) 6 months after surgery show an increase in the size of the metastatic lymph node (arrow in b) and soft-tissue thickening around the bronchus intermedius (arrow in c).
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Figure 22b. Locoregional recurrence in a 72-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) Initial follow-up CT scan (5-mm section thickness) obtained at the level of the thoracic inlet 3 months after surgery shows a round, 4-mm lymph node (arrow) in the right recurrent laryngeal nerve lymph node chain. (b, c) Follow-up CT scans (5-mm section thickness) obtained at the level of the thoracic inlet (b) and bronchus intermedius (c) 6 months after surgery show an increase in the size of the metastatic lymph node (arrow in b) and soft-tissue thickening around the bronchus intermedius (arrow in c).
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Figure 22c. Locoregional recurrence in a 72-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) Initial follow-up CT scan (5-mm section thickness) obtained at the level of the thoracic inlet 3 months after surgery shows a round, 4-mm lymph node (arrow) in the right recurrent laryngeal nerve lymph node chain. (b, c) Follow-up CT scans (5-mm section thickness) obtained at the level of the thoracic inlet (b) and bronchus intermedius (c) 6 months after surgery show an increase in the size of the metastatic lymph node (arrow in b) and soft-tissue thickening around the bronchus intermedius (arrow in c).
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Figure 23a. Celiac lymph node recurrence in a 71-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained 2 months after surgery shows a small (8-mm) celiac lymph node (arrow), a finding that suggests metastasis. However, FDG PET performed 2 days later was negative. (b) Follow-up CT scan obtained 4 months after surgery shows a 3-cm necrotic celiac lymph node metastasis (arrow). (c) FDG PET scan obtained the same day as b is still negative.
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Figure 23b. Celiac lymph node recurrence in a 71-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained 2 months after surgery shows a small (8-mm) celiac lymph node (arrow), a finding that suggests metastasis. However, FDG PET performed 2 days later was negative. (b) Follow-up CT scan obtained 4 months after surgery shows a 3-cm necrotic celiac lymph node metastasis (arrow). (c) FDG PET scan obtained the same day as b is still negative.
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Figure 23c. Celiac lymph node recurrence in a 71-year-old man with SCC of the middle thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained 2 months after surgery shows a small (8-mm) celiac lymph node (arrow), a finding that suggests metastasis. However, FDG PET performed 2 days later was negative. (b) Follow-up CT scan obtained 4 months after surgery shows a 3-cm necrotic celiac lymph node metastasis (arrow). (c) FDG PET scan obtained the same day as b is still negative.
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Figure 24a. Anastomotic recurrence with tracheal invasion in a 67-year-old man with SCC of the upper thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained at the level of the thoracic inlet 6 months after surgery shows a recurrent tumor at the anastomosis site (arrow) and diffuse thickening of the adjacent trachea (arrowheads). (b) Bronchoscopic image shows irregular nodular tumor infiltration along the tracheal wall.
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Figure 24b. Anastomotic recurrence with tracheal invasion in a 67-year-old man with SCC of the upper thoracic esophagus. The patient had undergone an Ivor Lewis procedure. (a) CT scan (5-mm section thickness) obtained at the level of the thoracic inlet 6 months after surgery shows a recurrent tumor at the anastomosis site (arrow) and diffuse thickening of the adjacent trachea (arrowheads). (b) Bronchoscopic image shows irregular nodular tumor infiltration along the tracheal wall.
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Figure 25. Locoregional recurrence in the left recurrent laryngeal nerve lymph node chain in a 64-year-old man with SCC of the upper thoracic esophagus. The patient had undergone a McKeown procedure. CT scan (5-mm section thickness) obtained at the level of the thoracic inlet 4 months after surgery shows metastatic lymph nodes (arrow) in the left recurrent laryngeal nerve lymph node chain.
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Figure 26. Distant recurrence in a 47-year-old man with SCC of the lower thoracic esophagus. The patient had undergone an Ivor Lewis procedure. Coronal reformatted image from contrast-enhanced CT data (4-mm section thickness) shows disseminated hepatic metastases, bilateral abdominal paraaortic lymph node metastases (arrows), and ascites (arrowheads), findings that are suggestive of peritoneal seeding.
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Figure 27. Distant recurrence in a 54-year-old man with SCC of the upper thoracic esophagus. The patient had undergone a McKeown procedure. CT scan (1-mm section thickness) obtained at the level of the thoracic inlet 1 year after surgery shows two pulmonary nodules (arrows) that are suggestive of metastases. The nodules were larger at follow-up CT.
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Figure 28. Pleural seeding in a 69-year-old man with SCC of the lower thoracic esophagus. The patient had undergone an Ivor Lewis procedure. CT scan (5-mm section thickness) obtained 10 months after surgery shows multiple pleura-based nodules (arrowheads), a finding that is consistent with pleural seeding.
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Copyright © 2007 by the Radiological Society of North America.
