CTICasesPleural Mesothelioma
Imaging findings
Chest CT shows a massive left pleural effusion causing mass effect with mediastinal shift and diaphragmatic inversion (tension hydrothorax). Smooth, diffuse pleural thickening is present. Thoracentesis psychologies were twice negative, but surgical pleural biopsy confirmed biphasic mesothelioma.
Key takeaways
Mesothelioma can present as a large, recurrent pleural effusion with mass effect. Cytology has limited sensitivity (60-80%) and cannot easily demonstrate invasion of extrapleural fat, frequently necessitating a core needle or surgical biopsy for confirmation.
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