CTICasesMalignant Mesothelioma
Imaging findings
Chest CT shows a moderate-sized left-sided pleural effusion accompanied by subtle, nodular, and lobulated pleural-based soft-tissue thickening along the mediastinal and costal pleura, and extending down the lateral recess adjacent to the spleen. PET/CT shows intense FDG avidity in these pleural thickenings. Biopsy confirms malignant mesothelioma, showing positive staining for calretinin and WT1, and negative staining for TTF1.
Key takeaways
Malignant mesothelioma is a highly aggressive neoplasm arising from mesothelial cells of the pleura, peritoneum, or pericardium. While asbestos exposure is the most famous risk factor, mesothelioma can occur in females without asbestos history. On CT, early disease can present as subtle nodularity or thickening along mediastinal or diaphragmatic pleural surfaces that can be easily overlooked, and PET/CT is highly helpful to identify active disease sites for biopsy.
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