CTICasesSarcomatoid Mesothelioma with Rapidly Progressive Calcification
Imaging findings
A welder with a prior radiograph showing low lung volumes and tortuous aorta later developed a right pleural effusion with lumpy pleural-based tumor nodules and modest calcification, without pleural plaques and without prior talc pleurodesis; biopsy confirmed sarcomatoid mesothelioma. A follow-up CT only about four weeks later showed markedly increased, more extensive calcification within the pleural mass, and at surgery the right lung was found to be trapped and non-expansile, precluding pleurodesis.
Key takeaways
Sarcomatoid mesothelioma can occasionally show rapidly progressive, extensive intratumoral calcification/ossification over just weeks, a feature reported anecdotally with the sarcomatoid subtype; absence of pleural plaques does not exclude an asbestos-related mesothelioma, since roughly half of mesotheliomas lack visible plaques and the dose of asbestos needed to cause plaque formation may exceed the dose needed to cause mesothelioma, and welders are a recognized at-risk occupation for asbestos exposure via insulation materials.
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