CTICasesRadiation-Induced Mesothelioma
Imaging findings
CT of the chest in a patient presenting with a right pleural effusion shows multiple discrete, lobulated pleural-based tumor masses along the costal and mediastinal pleura, with round atelectasis in the adjacent lung. Chronic radiation scarring is present in both lung apices. The patient has a history of Hodgkin lymphoma treated 14 years prior with mantle radiation boost (48 Gray) and autologous stem cell transplant. Biopsy of a pleural mass confirms malignant mesothelioma.
Key takeaways
Radiation-induced mesothelioma is a rare but well-documented secondary malignancy that can occur decades after radiation therapy, particularly in survivors of Hodgkin lymphoma treated with mantle radiation. It is clinically and histologically identical to asbestos-induced mesothelioma but occurs in younger patients without asbestos exposure. Pembrolizumab (immunotherapy) is a treatment option but can cause severe immune-related side effects such as uveitis, dermatitis, and joint effusions.
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See all cases from January 21, 2018 →