175 Diffuse Malignant Pleural Mesothelioma

CASE 175


image Clinical Presentation


83-year-old man with malaise and right-sided pleuritic chest pain


image Radiologic Findings


Coned-down PA chest radiograph (Fig. 175.1A) demonstrates a moderate right pleural effusion and moderate pleural thickening along the lateral right pleural surface that extends into the interlobar fissure. Coronal T2-weighted MR image (Fig. 175.1B) shows circumferential right pleural thickening by high-signal nodular masses. Note extension into the interlobar fissure and right costodiaphragmatic recess, involvement of the mediastinal pleura, and invasion of the diaphragm and mediastinum. Contrast-enhanced chest CT (mediastinal window) (Figs. 175.1C, 175.1D) reveals the right pleural effusion; extensive plaque-like and nodular pleural thickening along the costal, diaphragmatic, and mediastinal pleural surfaces; and nodular involvement of the minor fissure.



image


Fig. 175.1


image Diagnosis


Diffuse Malignant Pleural Mesothelioma


image Differential Diagnosis


• Pleural Effusion of Non-Neoplastic Etiology


• Malignant Pleural Effusion; Pleural Metastases (adenocarcinoma, carcinoma of other cell type, lymphoma)


image Discussion


Background


Diffuse malignant pleural mesothelioma is a relatively rare pleural malignancy. It is the most common primary pleural neoplasm.


Etiology


The majority of cases of malignant pleural mesothelioma (80–90%) are related to the carcinogenic effects of asbestos, and most lesions occur in individuals with documented occupational or environmental asbestos exposure. Approximately 6% of asbestos workers will develop mesothelioma. While a higher incidence of mesothelioma is observed in patients with continuous exposure to asbestos, intermittent, brief, and indirect exposures have also been implicated in the development of this neoplasm. Occupations with increased exposure to asbestos include construction, shipyard, and insulation work. The latency period between onset of exposure and development of mesothelioma is between 20 and 40 years. Both amphibole and chrysotile asbestos fibers are associated with the development of mesothelioma. Amphiboles are long, needle-like fibers that penetrate deeply into the lung, resist clearance, and are considered more tumorogenic than the serpiginous chrysotile asbestos fibers.


Clinical Findings

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Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on 175 Diffuse Malignant Pleural Mesothelioma

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