대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 155 Date 2000-10-14

  • Courtesy of Eun-Young Kang, M.D. / Korea University Guro Hospital
  • Age/Sex 26 / M
  • Chief ComplaintDyspnea, cough, fever, and sputum for two months
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Malignant Mesothelioma
Radiologic Findings
Chest radiographs (Fig 1,2) and CT scans (Fig. 3, 4) show extensive nodular pleural masses encasing the lung and extending into interlobar fissure in right hemithorax.
The pleural masses show some internal low-density areas and there is no evidence of adjacent chest wall invasion on CT scan.
Small amount of pleural fluid collection is noted.
Pleural biopsy was done for the diagnosis and showed invasion of adjacent chest wall
and no evidence of tumor necrosis was found histologically in contrast to findings on CT scan.
Brief Review
Malignant mesothelioma is an uncommon and fatal neoplasm of the pleura.
Asbestos exposure is found in about half of all patients with diffuse malignant mesothelioma.
The interval between first exposure to asbestos and presentation with the tumor is in the order of 20 to 40 years.
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. Armstrong P, Wilson AG, Dee P, Hansell DM. Imaging of disease of the chest. 3rd ed. Mosby, London, 2000, 376-379
Keywords
Pleura, Malignant tumor,

No. of Applicants : 36

▶ Correct Answer : 28/36,  77.8%
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  • - AZ vesalius Tongeren, Belgium Rudi Stokmans
  • - CHU Nancy-Brabois, Vandoeuvre les Nancy cedex, France Denis REGENT
  • - Dong-A University Hospital Ki-Nam Lee
  • - Gachon Medical School Gil Medical Center Seo Joon Beom
  • - Hospital de Guipuzcoa / San Sebastian / Spain Gonzalo Vega - Hazas Porrua
  • - Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami
  • - Ospedale di Fabriano, Italy Giancarlo Passarini
  • - Sakuragaoka, Kagoshima city, Kagoshima, Japan Yasutaka Baba
  • - Samsung Medical Center, Sungkyunkwan University Kyung Soo Lee
  • - Seoul National University Hospital Seong Ho Park
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Vilvendhan Rajendran
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