CTICasesComplex Pleuropulmonary Lymphatic-Venous Malformation
Imaging findings
CT in an 82-year-old man demonstrates loculated low-attenuation material along the right pleural surface and in the right fissure that has been stable since at least 1997 on historical imaging. The material follows the fissural surfaces and pleura, has smooth interfaces with lung, contains calcifications, and contains old metallic coils. Pulmonary veins appear to course through or adjacent to the lesion. Large bronchial arteries are also identified supplying the right lung. The overall pattern, involving both lymphatic and venous components along the pleura and fissures, is consistent with a complex lymphatic-venous malformation.
Key takeaways
Complex lymphatic-venous malformations can involve the pleural surfaces, interlobar fissures, and mediastinum, producing a chronic multi-compartment lesion that on CT resembles loculated pleural effusion but is stable over decades. The finding of coils (from prior attempted intervention), calcifications, and large bronchial arteries in association with the complex fluid density along the pleura and fissures is characteristic of this entity. Terminology for mixed lymphatic-venous malformations can be confusing, but these are distinct from pure venous or pure lymphatic malformations and may have venous drainage to the systemic circulation.
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