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Weekly Chest CasesArchive of Old Cases

Case No : 934 Date 2015-09-21

  • Courtesy of Ji Young Rho, MD / CHA Bundang Medical Center, CHA University
  • Age/Sex 67 / M
  • Chief ComplaintDyspnea on exertion for two months
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Malignant pleural mesothelioma
Radiologic Findings
Axial contrast-enhanced CT scans show diffuse, nodular, circumferential pleural thickening extending into the interlobar fissure with a large amount of pleural effusion in the left hemithorax. Note the noncalcified pleural plaque or thickening in the right anterior hemithorax that is suggestive of asbestos exposure. Additionally a few left retrocrural enlarged lymph nodes are seen.
The patient had a history of asbestos exposure. Percutaneous pleural needle biopsy under the CT guidance was done for the diagnosis and the lesion was diagnosed as malignant pleural mesothelioma.
Brief Review
Mesothelioma of the thorax is a malignant neoplasm that involves the parietal pleura to a greater extent than the visceral pleura (1). There is a significantly increased risk of developing this disease in those individuals with prior exposure to asbestos (2). There is a long latent period of approximately 35–40 years for the development of asbestos-related mesothelioma (1).
The typical patient with mesothelioma presents with symptoms of chest pain, dyspnea, and recurrent pleural effusions (3) and has a history of significant asbestos exposure in those individuals with prior exposure to asbestos (2).
CT is the primary imaging modality used for the evaluation of malignant pleural mesothelioma. Key CT findings that suggest malignant pleural mesothelioma include unilateral pleural effusion, nodular pleural thickening, and interlobar fissure thickening (1). CT scanning also is used to identify signs of asbestos exposure, such as plaques (4).
References
1. Miller BH, Rosado-de-Christenson ML, Mason AC, Fleming MV, White CC, Krasna MJ. Malignant pleural mesothelioma: radiologic-pathologic correlation. RadioGraphics 1996; 16:613-644.
2. Tyszko SM, Marano GD, Tallaksen RJ, et al. Best cases from the AFIP: Malignant mesothelioma. RadioGraphics 2007; 27:259-264.
3. Lee YC, Light RW, Musk AW. Management of malignant pleural mesothelioma: a critical review. Curr Opin Pulm Med 2000;6:267–274.
4. Bruce W.S. Robinson, M.D., and Richard A. Lake, Ph.D. Advances in Malignant Mesothelioma. N Engl J Med 2005;353:1591-603.
Keywords
Pleura, Malignant tumor,

No. of Applicants : 83

▶ Correct Answer : 59/83,  71.1%
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - CRA , Morocco Abdelhafid SBIHI
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - Shanghai Jiao Tong University Affiliated Sixth People萸 , China Jiayin Zhang
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - radiologist, aditya imaging centre , India vivek patel
  • - Samsung Medical Center , Korea (South) Jeonghyun Lee
  • - privato , Italy genchi enzo
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - McGill University Health Center , Canada Alexandre Semionov
  • - MBAL Rousse , Bulgaria Emil Parashkevov
  • - Himeji Redcross Hospital , Japan Soichiro Okamoto
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Kyoto University , Japan Akihiko Sakata
  • - University of British Columbia , Canada Amr Ajlan
  • - Scans world , India Philson Mukkada
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - �stanbul , Turkey Ayhan Yilmaz
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Niigata University , Japan Atsushi Uehara
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - university of montreal , Canada Andrei Gorgos I
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - CNUH , Korea (South) Noh Hoon
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Kosin University Gospel Hospital , Korea (South) Hee Kang
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - CHU Poitiers , France CHAN paul
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - CLCC Rennes , France nicolas gautier
  • - NASA SCANS , India RAKESH BHATIA
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Santosh hospital,Bengaluru , India Pravin Mahadevappa
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Pusan national university hospital , Korea (South) Ji Bae
  • - Pusan National University Hospital , Korea (South) LEE YOU JIN
  • - Busan national univercity hospital radiology department , Korea (South) Il-wan Son
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - PNUH , Korea (South) Seungbaek Hong
  • - pusan national university hospital , Korea (South) kim jeongmyeong
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Pusan national university of hospital , Korea (South) Jo eun
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 22/83,  26.5%
  • - Tashkent Medical Academy , Uzbekistan Rustam Fayzullaev
  • - Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Universidad de Chile , Chile Alvaro Zuniga
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
  • - chp st martin , France Mariotte benoit
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
  • - chungbuk national university hospital , Korea (South) jeehye kim
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - CHU Poitiers , France Yannick DE LA TORRE
  • - Wuhan Union Hospital , China Qiguang Cheng
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