*62 year-old man with dyspnoea
What is the most likely diagnosis?
1. Pleural fibrosis
2. Bronchogenic carcinoma
3. Mesothelioma
4. Benign asbestos related pleural disease
Answer
Answer: Mesothelioma
Chest radiograph reveals opacification in the middle and lower zones of the left lung. CT demonstrates pleural effusion and nodular pleural thickening, involving the parietal and visceral pleura, encasing the left lung. Moreover, CT shows the pericardial involvement (arrow).
Mesothelioma is generally an aggressive malignant tumour. It commonly arises from the pleura.It is a rare entity and accounts for 5-28% of all malignant pleural tumours. There is a strong association between mesothelioma risk and asbestos exposure (1, 2).
Chest radiograph is commonly non-specific, showing a pleural opacity which may extend around lung. CT is frequently used modality for the assessment of mesothelioma. CT demonstrates a soft tissue attenuation nodular mass which spreads along pleura involving into pleural fissures. CT shows direct invasion of adjacent structures (3).
References:
1. Naidich DP, Srichai MB, Krinsky GA. Computed tomography and magnetic resonance of the thorax. Lippincott Williams & Wilkins. (2007) ISBN:0781757657.
2. Leung AN, Müller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR Am J Roentgenol. 1990;154 (3): 487-92.
3.Tyszko SM, Marano GD, Tallaksen RJ et-al. Best cases from the AFIP: Malignant mesothelioma. Radiographics. 27 (1): 259-64.