Miliary Mesothelioma

Our plain-English summary of Miliary Mesothelioma, by D. Jayabalan, M. Donaghy, C. Charlesworth, et al (Respirology Case Reports, 2025).

The study

• Authors: D. Jayabalan, M. Donaghy, C. Charlesworth, E. Fysh, Y.C.G. Lee
• Journal: Respirology Case Reports
• Published: 2025;13(3):e70141
• Read it: PubMed · Publisher · Free full text

Abstract

Miliary spread of mesothelioma is a rare but important manifestation of late-stage disease, likely due to hematogenous dissemination. This case highlights characteristic CT imaging findings, emphasizing the need for awareness among clinicians and radiologists. Recognizing this pattern can aid in diagnosis, prognostication, and appropriate referral for palliative management.

© 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This article is a short clinical image report about one patient. A 74-year-old man developed right pleural mesothelioma. The authors described it as associated with asbestos exposure from working with insulation material as an engineer. The article did not name a fiber type. Fluid from around the lung showed epithelioid mesothelioma cells, and infection was ruled out. The patient received dual immunotherapy (ipilimumab and nivolumab) and radiotherapy for tumour track metastases. Five months after starting treatment, a CT scan showed the disease had progressed. There was more pleural tumour, enlarged lymph nodes, and many fine deposits in both lungs, which the authors described as consistent with miliary spread of mesothelioma. On a repeat CT two months later, the nodules had grown and looked more merged together. The patient was referred to palliative care. The authors concluded that miliary lung involvement, presumed to come from spread through the bloodstream, is rare but should be considered in patients with late-stage disease, especially when the imaging is characteristic. A single case does not show how often this happens.

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: Clinical image report (single case report)
• Who was studied: One 74-year-old man with right pleural mesothelioma (Western Australia author group; dates of care not given)
• Exposure: Asbestos exposure from working with insulation material as an engineer; fiber type not stated
• Main results:
  • Pleural fluid analysis found epithelioid mesothelioma cells; infection was excluded
  • The patient received dual immunotherapy (ipilimumab and nivolumab) and radiotherapy for tumour track metastases
  • Disease progression (increased pleural tumour and lymphadenopathy) was seen on CT 5 months after starting systemic therapy
  • Numerous fine deposits in both lungs were seen, consistent with miliary spread of mesothelioma
  • The nodules progressed and appeared more confluent on repeat CT 2 months later
  • The patient was referred to palliative care
• The authors' conclusion: The authors concluded that miliary lung involvement, presumed to come from spread through the bloodstream, is rare but should be considered in patients with late-stage disease, especially with characteristic imaging

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Palliative Care.

Related studies

• Miliary spread of malignant pleural mesothelioma without a clinically identifiable pleural tumour — A.W. Musk, J. Dewar, et al. (1991)
• Miliary mesothelioma — M. Huncharek (1994)
• Epithelioid pleural mesothelioma concurrently associated with miliary pulmonary metastases and minimal change nephrotic syndrome - A hitherto undescribed case — Y. Tsukamoto, T. Otsuki, et al. (2015)
• Diffuse intrapulmonary malignant mesothelioma presenting with miliary pulmonary nodules: A case report — T. Hida, M. Hamasaki, et al. (2015)
• Miliary mesothelioma: a new clinical and radiological presentation in mesothelioma patients with prolonged survival after trimodality therapy — L. Purek, S. Laroumagne, et al. (2011)
• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)

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