Malignant pleural mesothelioma: CT manifestations in 50 cases

Our plain-English summary of Malignant pleural mesothelioma: CT manifestations in 50 cases, by A. Kawashima, H.I. Libshitz (AJR. American Journal of Roentgenology, 1990).

The study

• Authors: A. Kawashima, H.I. Libshitz
• Journal: AJR. American Journal of Roentgenology
• Published: 1990;155(5):965-9
• Cited by: 97 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. 003745).

Abstract

Malignant pleural mesothelioma, a rare and usually fatal neoplasm that is associated with asbestos exposure, is being encountered with increasing frequency. Pretreatment CT findings from 50 patients with malignant pleural mesothelioma are illustrated. Pleural thickening was found in 46 (92%) of the 50 patients, thickening of the pleural surfaces of the interlobar fissures in 43 (86%), pleural calcifications in 10 (20%), and pleural effusions in 37 (74%). The volume of the involved hemithorax varied appreciably. Contractions of the involved hemithorax was noted in 21 (42%) of 50 patients and contralateral mediastinal shift in seven (14%). Disease beyond the parietal pleura was found in the chest wall (nine patients), mediastinum, lymph nodes, and diaphragm.

In plain English

In this pictorial essay, the authors retrospectively reviewed CT scans taken before treatment in 50 patients (45 men and five women) with malignant pleural mesothelioma. The patients were seen at their Houston cancer center from June 1980 through January 1990. A definite history of asbestos exposure was present in 24 (48%), and no fiber types were named. Pleural thickening was the most common finding, seen in 46 of 50 patients (92%). Thickening along the interlobar fissures was seen in 43 (86%), pleural effusions in 37 (74%) and pleural calcifications in 10 (20%). Four patients had calcified plaques on both sides in keeping with asbestos-related disease. The affected side of the chest had shrunk in 21 patients (42%). In seven (14%), the central chest structures were pushed toward the other side. Chest wall invasion was seen in nine patients (18%), including five of 11 with sarcomatoid tumors. The authors pointed out that a 'frozen' mediastinum and volume loss, suggested as diagnostic features, need not be present. They also noted that effusion can be hard to tell apart from true pleural thickening on CT.

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: Pictorial essay based on a retrospective review of pretreatment CT findings, with follow-up CT scans in some patients
• Who was studied: 50 patients (45 men, five women; mean age 59, range 37 to 85) with malignant pleural mesothelioma, seen at The University of Texas M. D. Anderson Cancer Center, Houston, from June 1980 through January 1990. Of the 44 tumors that could be subtyped, 30 were epithelial, 11 sarcomatoid and three mixed. 25 patients had follow-up CT scans.
• Exposure: A definite history of asbestos exposure in 24 of 50 patients (48%). No fiber types, products, jobs or doses are given. One patient had had radiation therapy to the thorax 30 years earlier for breast cancer.
• Main results:
  • Pleural thickening was seen in 46 (92%) of the 50 patients.
  • Focal pleural masses were seen in four patients (8%), all of whom had pleural effusions.
  • Thickening of the pleural surfaces of the interlobar fissures was seen in 43 (86%) of the 50 patients.
  • Pleural effusions were present in 37 (74%) of the 50 patients.
  • Pleural calcifications were seen in 10 patients (20%).
  • Calcified plaques in keeping with asbestos-related disease were seen on both sides in four patients.
  • None of the patients had radiologic evidence of pulmonary fibrosis.
  • Contraction of the involved hemithorax (the affected side of the chest) was noted in 21 patients (42%).
  • Contralateral mediastinal shift (central chest structures pushed toward the other side) was seen in seven patients (14%).
  • Chest wall invasion was seen in nine patients (18%), with obvious rib involvement in five (10%).
  • Among the 11 sarcomatoid tumors, chest wall invasion was present in five (45%), four of which had rib destruction.
  • Lymph nodes 1 cm or larger were found in 61 nodal groups in 29 patients.
  • Of the 20 patients who had radical surgery or autopsy, eight had lymph nodes proved to contain metastases.
  • Among 22 medically treated patients with serial CT scans, the disease progressed in 16, showed no appreciable change in three, improved in two and had a mixed response in one.
• The authors' conclusion: The authors noted that a 'frozen' mediastinum and loss of volume of the involved side have been suggested as diagnostic features. However, a large effusion or bulky mass can push the mediastinum to the other side, so volume loss or fixation of a hemithorax need not be present.
• Limitations the authors state:
  • On CT, pleural effusion is difficult to distinguish from true pleural thickening, especially without nodularity and when involvement is not extensive.
  • Involvement of the minor fissure may be difficult to identify on CT.
  • Thin-section CT scans were not obtained when assessing pulmonary fibrosis.
  • Pericardial disease was likely more common than the eight cases proved at surgery or autopsy.

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, Neoplasm, Asbestos Exposure, Pleural Thickening, Pleural Calcification, Pleural Effusion, Hemithorax, Parietal Pleura.

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