CTICasesEpithelioid Mesothelioma (Localized/Mediastinal presentation)
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Imaging findings
Multiple small pleural deposits and a well-rounded, lobulated anterior mediastinal mass, which was hyperintense on T2-weighted imaging, restricted diffusion, and enhanced after contrast on MRI. It was challenging to determine if the mass was invading or just pushing the lung.
Key takeaways
This was an unusual presentation of epithelioid mesothelioma, localized to the anterior mediastinum/pleural region, without typical infiltrative pleural thickening, and no clear asbestos exposure. Pathologically, mesothelioma can be confused with thymic carcinoma or synovial sarcoma due to similar immunohistochemistry. MRI with free-breathing sequences can be useful to assess lung slip around the lesion to differentiate invasion from abutment.
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