CT of malignant pleural mesothelioma

Our plain-English summary of CT of malignant pleural mesothelioma, by E. Alexander, R.A. Clark, D.P. Colley, et al (AJR. American Journal of Roentgenology, 1981).

The study

• Authors: E. Alexander, R.A. Clark, D.P. Colley, S.E. Mitchell
• Journal: AJR. American Journal of Roentgenology
• Published: 1981;137(2):287-91
• Type of article: Case report
• Cited by: 61 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001808).

Abstract

Malignant pleural mesothelioma is a rare tumor. Although the chest film findings of pleural mesothelioma are well described, there are few descriptions of the findings of computed tomography (CT). This report describes the CT findings in five cases of pleural mesothelioma. In each case the CT showed an extensive, irregular, pleural-based mass surrounding the lung, spreading into the fissures, and extending into the mediastinum. In two cases there was also extension into the contralateral chest, and in one case each there was extension into the abdomen and chest wall. In each case the chest radiographs underestimated the extent of disease, when compared to CT. When an irregular, pleural-based mass involving most of the hemithorax is identified on CT, the diagnosis of mesothelioma can be suggested and at the same time the extent of the tumor may be evaluated. This is important because the diagnosis of mesothelioma is difficult and because treatment and prognosis may depend on the extent of the disease.

In plain English

This article reported five patients with malignant pleural mesothelioma seen in one year at the University of Cincinnati Medical Center, all examined with computed tomography (CT). Only one patient, a 52-year-old machine operator, had known occupational asbestos exposure. The article named no fiber types. Four patients were diagnosed from tissue samples, one of them at autopsy. In the fifth, mesothelioma was presumed from the clinical course and an otherwise negative workup. In every case CT showed an irregular mass along the pleura surrounding the lung, reaching into the fissures and the mediastinum. In two cases the tumor crossed into the other side of the chest, and in one case each it reached the chest wall or the abdomen. In each case plain chest films underestimated the extent of disease compared with CT. The authors noted that similar CT findings can occur in metastatic carcinoma and that disease was extensive in all five patients. They concluded that such a mass on CT should suggest malignant pleural mesothelioma.

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: Case series (five case reports) describing CT findings
• Who was studied: Five patients with pleural mesothelioma seen over one year at the University of Cincinnati Medical Center, all studied with CT. They were a 59-year-old nun, a 68-year-old retired television repairman, a 68-year-old retired butcher, a 52-year-old machine operator and a 55-year-old cement worker.
• Exposure: Only one patient (the 52-year-old machine operator) had known occupational asbestos exposure. The other four had no known asbestos exposure. No fiber types, products or doses were described.
• Main results:
  • In all five cases, CT showed tumor surrounding the lung and extending into the fissures, with extension into the mediastinum in every case.
  • In two of the five cases the tumor extended into the opposite side of the chest. In one case it extended into the chest wall, and in one case into the abdomen.
  • In all five cases, chest radiographs underestimated the extent of disease compared with CT.
  • In four cases the diagnosis was made before CT, which was done to evaluate extent. In case 5 the diagnosis was first suggested by CT and was confirmed at autopsy as mixed cell type mesothelioma.
  • In case 2 (the retired television repairman), mesothelioma was not confirmed by pathology. It was presumed from the clinical course and an otherwise negative workup.
• The authors' conclusion: The authors concluded that when CT shows an irregular pleural-based mass surrounding the lung, possibly invading nearby structures, the diagnosis of malignant pleural mesothelioma should be suggested. They also concluded that CT can show the extent of the tumor.
• Limitations the authors state:
  • Disease was extensive in all five patients, so the case series does not show how CT performs in less advanced disease.
  • The CT findings are not unique to mesothelioma; similar findings may be seen in metastatic carcinoma.
  • CT attenuation values did not help the authors distinguish pleural fluid from pleural tumor.
  • A pleural effusion can hide a pleural mass on CT.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chest X-Ray, Mediastinum, Hemithorax, Mesothelioma, Prognosis.

Related studies

• CT findings in malignant pleural mesothelioma related to nonoccupational exposure to asbestos and fibrous zeolite (erionite) — C. Erzen, M. Eryilmaz, et al. (1991)
• Chest CT combined with artificial pneumothorax: value in determining origin and extent of tumor — A. Watanabe, K. Shimokata, et al. (1991)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Computer tomography in the evaluation of pulmonary asbestosis. Preliminary experiences with the EMI general purpose scanner — L. Kreel (1976)
• CT and MR in pleural disease — T.C. McLoud (1998)
• Concerning CT features predict outcome of treatment in patients with malignant peritoneal mesothelioma — P.H. Sugarbaker, D. Chang, et al. (2021)

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