Mesothelioma CT

Mesothelioma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Chest CT scan may be diagnostic of mesothelioma. CT is the most commonly used modality for the assessment of mesothelioma and is able to stage the disease accurately in most patients.

CT Scan

• CT is the most commonly used modality for the assessment of mesothelioma and is able to stage the disease accurately in most patients.
• The appearance is that of a soft tissue attenuation nodular mass which spreads along pleural surfaces including into pleural fissures and often creating a pleural rind.
• Calcification is seen in 20% of cases which usually represents engulfed calcified pleural plaques rather than true tumour calcification.
• Sarcomatoid variants may demonstrate osteosarcoma or chondrosarcomatous components which may also be calcified.
• An uncommon variant is the solitary mediastinal malignant mesothelioma which has appearances reminiscent of a solitary fibrous tumour of the pleura.
• Mesotheliomas have a predilection for direct invasion of adjacent structures (chest wall, diaphragm and mediastinal content) but also frequently metastasise to the contralateral lung and local nodes.
• To confidently predict chest wall invasion the extrapleural fat plane should be seen to be infiltrated and/or direct extension in bone or muscle identified.
• Presence of a pericardial effusion suggests transpericardial extension.

References

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