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Weekly Chest CasesArchive of Old Cases

Case No : 1006 Date 2017-02-06

  • Courtesy of Kwang-Nam Jin, MD., Ye-Ra Choi, MD., Hyoun Cho, MD. / SMG - SNU Boramae Medical Center
  • Age/Sex 66 / M
  • Chief ComplaintCXR abnormality on routine check up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Malignant pleural mesothelioma
Radiologic Findings
Figs 1. Chest PA view shows mass like opacity with incomplete border sign in the right upper lung zone.
Fig 2-3. Mediastinal window setting of axial image shows lobulated enhancing peripheral mass in the right upper lobe (RUL), broadly-abutting pleura. On coronal image, the mass is a pleural-based mass associated with pleural thickening.
Fig 4. Lung window setting shows smooth border of the mass in the RUL.
Brief Review
Malignant pleural mesothelioma (MPM) is an uncommon neoplasm that arises from the pleura or, rarely, the pericardium or peritoneum. CT findings that suggest MPM are unilateral pleural effusion, nodular pleural thickening, and interlobar fissure thickening. Growth typically leads to tumoral encasement of the lung with a rind-like appearance.
MPM is locally aggressive, with frequent invasion of the chest wall, mediastinum, and diaphragm. Chest wall involvement may manifest as obliteration of extrapleural fat planes, invasion of intercostal muscles, displacement of ribs, or bone destruction. However, irregularity of the interface between the chest wall and the tumor is not a reliable predictor of chest wall invasion. Occasionally, MPM can extend into the chest wall via needle biopsy tracks, surgical scars, and chest tube tracts. Direct extension of the tumor into vascular structures and mediastinal organs including the heart, esophagus, and trachea may occur. There is usually obliteration of surrounding fat planes, and the presence of a soft-tissue mass that surrounds more than 50% of the circumference of a vascular structure is strong evidence of invasion. MPM may invade the pericardium and can be seen at CT as nodular pericardial thickening or pericardial effusion.
References
1. RadioGraphics 2004; 24:105–119 Malignant Pleural Mesothelioma: Evaluation with CT, MR Imaging, and PET
Keywords
Pleura,

No. of Applicants : 112

▶ Correct Answer : 7/112,  6.3%
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Other , Korea (South) HAYEON LEE
  • - Seoul National University Hospital , Korea (South) KUM JU CHAE
  • - GHICL , France MANUEL TOLEDANO
  • - University of Utah , United States AKIHIKO SAKATA
  • - Korea University Ansan Hospital , Korea (South) CHERRY KIM
▶ Correct Answer as Differential Diagnosis : 27/112,  24.1%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Otsu Municipal Hospital , Japan NORIATSU ICHIBA
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Union hospital,Wuhan , China Nan Diao
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - tongji medical university affiliated jingzhou central hospital , China HUANG YUAN YI
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Dong-a University Medical Center , Korea (South) WON JIN CHOI
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Avrasya Hospital , Turkey MURAT ULUSOY
  • - Kanto Rosai Hospital , Japan TAKU TAJIMA
  • - , Australia RASHID HASHMI
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Maternity & child hospital , Saudi Arabia Sania Ali ALBlushi
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Private sector , Greece VASILIOS TZILAS
  • - Manipal hospitals , India ELAKYA ARUL
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