Computed tomographic assessment of patients following radical surgery for malignant mesothelioma

Our plain-English summary of Computed tomographic assessment of patients following radical surgery for malignant mesothelioma, by H. Adams, E.G. Butchart (Clinical Radiology, 1992).

The study

• Authors: H. Adams, E.G. Butchart
• Journal: Clinical Radiology
• Published: 1992;45(2):120-4
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Serial computed tomographic (CT) scans of the thorax and upper abdomen were performed in eight patients following radical surgery (pleuro-pneumonectomy) for diffuse malignant mesothelioma of the pleura. The post-operative appearances included a well defined membrane lining the pleuro-pneumonectomy space in seven cases; in two cases this resembled the original tumour. In six patients there was upward abdominal visceral displacement on the side of the surgery due to diaphragmatic resection; this resulted in contralateral mediastinal shift in four patients. One patient required a diaphragmatic prosthesis which produced a distinctive CT appearance. CT suggested recurrent mesothelioma in five cases. Although two patients had evidence of intrathoracic recurrence, in three patients the only feature was the non-specific finding of abdominal ascites. The normal CT appearances after pleuro-pneumonectomy should be recognized to facilitate radiological interpretation. With careful application CT is of value for the assessment of recurrent disease in patients following radical surgery for malignant mesothelioma.

In plain English

This article retrospectively reviewed follow-up computed tomography (CT) scans of eight men who had radical surgery (pleuro-pneumonectomy) for diffuse malignant mesothelioma of the pleura at Llandough Hospital, South Glamorgan. The article did not describe the patients' asbestos exposure. A well defined 'membrane' lined the chest cavity in seven of the eight patients despite complete removal of the pleura. In two patients this membrane closely resembled the original tumour. Upward displacement of abdominal organs was seen in six patients, and the mediastinum was pushed away from the operated side in four. One patient needed a prosthetic diaphragm. Five patients died from recurrent tumour between 4 and 24 months after surgery. CT suggested recurrence in five cases. Two showed irregular thickening of the membrane, and in three the first sign was fluid in the abdomen (ascites). The authors noted that ascites could have other causes, such as right heart failure. They wrote that the patients' later progress strongly favoured recurrent abdominal tumour as the cause, but that definite histological or post-mortem proof was lacking. The authors concluded that this surgery may produce confusing CT appearances and that recurrence may show only non-specific signs.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective review of a case series (post-operative CT scans)
• Who was studied: Eight male patients aged 37 to 67 (mean 54) who had pleuro-pneumonectomy for diffuse malignant mesothelioma of the pleura over the previous 3 years at Llandough Hospital, Penarth, South Glamorgan. The tumour was right-sided in six patients and left-sided in two.
• Exposure: No asbestos exposure is reported. The study looked at CT appearances after radical surgery (pleuro-pneumonectomy, which included removal of the diaphragm on the affected side).
• Main results:
  • 22 post-operative chest CT scans were available for the eight patients, from 1 to 5 scans per patient.
  • In seven of the eight patients, a well defined 'membrane' lined the chest cavity despite complete removal of the pleura.
  • In two patients, the post-operative membrane resembled the original tumour.
  • Upward displacement of abdominal organs was seen in six of the eight patients and was marked in two.
  • In four patients, the mediastinum shifted away from the side of the surgery.
  • One patient (Case 1) needed a repeat operation with insertion of a prosthetic diaphragm after abdominal organs herniated into the chest.
  • Five patients died from recurrent tumour between 4 and 24 months after surgery.
  • CT suggested recurrence in five cases. In three of these patients, the first evidence of possible recurrence was abdominal ascites.
  • Two patients were apparently recurrence-free at 8 and 19 months after surgery.
• The authors' conclusion: The authors concluded that pleuro-pneumonectomy may produce confusing CT appearances, and that recurrent disease may show only non-specific features such as ascites.
• Limitations the authors state:
  • Ascites is non-specific and could have been caused by right heart failure rather than tumour.
  • In the patients with ascites, the patients' later clinical progress strongly favoured recurrent abdominal tumour as the explanation, but there was no definite histological or post-mortem proof.
  • Intravenous contrast was given in only half of the post-operative scans.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Thorax, Pneumonectomy, Pleura, Diaphragmatic Resection, Mesothelioma, Intrathoracic, Ascites.

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• Computed tomographic findings of environmental asbestos-related malignant pleural mesothelioma — U.M. Yilmaz, G. Utkaner, et al. (1998)
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