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]

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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