CTICasesPleural Mesothelioma Mimicking Coccidioidomycosis Pleural Disease
Imaging findings
Serial chest CT scans show a progressive, nodular, unilateral right-sided pleural effusion that eventually develops into a thick pleural rind. The patient, who lived in the endemic Central Valley, was initially diagnosed with coccidioidomycosis based on a non-diagnostic thoracentesis and started on antifungals. Surgical biopsy subsequently confirmed pleural mesothelioma.
Key takeaways
Nodular pleural thickening is highly specific for malignant disease (primary mesothelioma or metastasis) and should not be managed as benign infectious disease without tissue confirmation. Thoracentesis has suboptimal sensitivity (60-80%) for diagnosing pleural malignancy, and negative results should prompt pleural biopsy rather than presumptive treatment for fungal empyema.
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