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Weekly Chest CasesArchive of Old Cases

Case No : 551 Date 2008-05-19

  • Courtesy of Ki Yeol Lee, MD. / Korea University Ansan Hospital, Korea
  • Age/Sex 69 / M
  • Chief ComplaintPain on left chest wall (Du;10 days)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Malignant mesothelioma
Radiologic Findings
Chest radiographs show fibronodular opacities in both upper and mid-lung zone with apical pleural thickening suggesting inactive tuberculosis, and 5 cm x 3 cm mass-like lesion in the left upper lung zone showing spiculated medial margin.

Chest CT scan reveals 5.6 x 2.6 cm mass based on pleura showing air-bronchogram in the left upper lobe. We had differentiated primary lung cancer as the first choice rather than mass originated from the pleura. The patient had been underwent thoracoscopic biopsy for left upper lateral pleural mass and excisional biopsy for palpable left supraclavicular lymph node. Pathologic diagnosis from pleural mass and lymph node was malignant mesothelioma. This patient has no past history of asbestos exposure. Lung parenchyma seemed to be infiltrated by the pleural lesion.
Brief Review
Malignant mesothelioma is the most common primary malignancy of the pleura. Asbestos exposure is found in about half of all patients with diffuse malignant mesothelioma. Development of pleural mesothelioma occurs up to 40 years following exposure to asbestos.

The peak age at presentation is between 40 and 70 years, with male predominating. Imaging findings are essentially similar on chest radiographs, CT, and MRI. Imaging findings typically consist of extensive nodular or lobular thickening of the pleura, which may conglomerate to form a circumferential lobular sheet of soft tissue density encasing the lungs.

The tumor often runs into the fissures accompanied by varying amount of pleural effusions. Invasion of chest wall, adjacent lung, pericardium, other mediastinal structures, and diaphragm usually occur relatively late.

Lymphatic and hematogenous metastases are usually late manifestations.

The differential diagnosis includes pleural involvement by other malignant tumors as well as benign conditions such as asbestos-related benign pleural effusion, asbestos-related pleural plaque, tuberculous pleural thickening, and empyema.
References
1. Seely JM, Nguyen ET, Churg AM, M?ler NL. Malignant mesothelioma: Computed tomography and correlation with histology Eur J Radio 2008 Mar [Epub ahead of print]
2. Metintas M. Ucgun I, Erginel S, et al. Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases. European Journal of Radiology
2002;41:1-9
3. Wang ZJ, Reddy GP, Gotway MB, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics. 2004 Jan-Feb;24(1):105-19
Keywords
Pleura, Lung, Malignant tumor,

No. of Applicants : 79

▶ Correct Answer : 4/79,  5.1%
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - breach candy hosptial , India rohan kashyape
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - ICL , France Regis Labroye
▶ Correct Answer as Differential Diagnosis : 16/79,  20.3%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Kashan University of Medical Sciences, kashan, Iran , Iran Ebrahim Razi
  • - All India Institute of Medical Sciences , India puneet kochar
  • - kims , India kakarla bhaskar
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - brm hospital , India chemmandi sudhan
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Regional Imaging Ltd. - Riverina , Australia Rashid Hashmi
  • - Homs National Hospital , Syria Rami Abou zalaf
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
▶ Semi-Correct Answer : 50/79,  63.3%
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - National Taiwan University Hospital , Taiwan Nin Chieh Hsu
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - Cheongshim international medical center , Korea (South) yang Hae Jum
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Asan Medical Center , Korea (South) Eun Jin Chae
  • - Asian heart institute, Nirman Hitech & Apollo clinic , India Jeshil Shah
  • - hospital Sao Paulo , Brazil israel missrie
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - CHU Grenoble , France Fabrice Bing
  • - CATHAY GENERAL HOSPITAL, SIJHIH , Taiwan CHIH-HUNG LIN
  • - Mackay Memorial Hospital, Taipei, Taiwan , Taiwan Chia-Fu Tsai
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - ottawa , Canada nishard abdeen
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - University of Kocaeli , The faculty of Medicine , Turkey Salih Topcu
  • - Trakya University School of Medicine , Turkey Derya Demir
  • - CHRU lille , France manuel toledano
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - St. Mary Hospital , Korea (South) Jung GW
  • - Saga University, Japan , Japan Ryoko Egashira
  • - EKH-Berlin , Germany Michael Weber
  • - Hanyang university , Korea (South) Ji Young Kim
  • - mediciti hospitals , India paramjyothi gongati
  • - chp st martin , France Mariotte benoit
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - IRSA La Rochelle France , France Denis Chabassie
  • - , Korea (South) ui byun
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - radiology department ANNECY , France gilles GENIN
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - KMC, Manipal , India satish maddukuri
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - CARE hospital , India umadevi bhagavatula
  • - EKH-Berlin , Germany Holger Hartmann
  • - SHIVALIK USG CENTRE , India rajendra garg
  • - Assam medical college, INDIA , India karunakaran M
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Erciyes University Faculty of Medicine Thoracic Surgery Department , Turkey omer onal
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Hyun
  • - Mackay Memorial Hospital , Taiwan Shen ShengYeh
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - University of virginia , United States sucheta sharma
  • - IRIS, CARE HOSPITAL , India dipal shah
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