A 50-year-old asbestos-exposed worker has CT showing bilateral calcified pleural plaques, bilateral pleural thickening, and a new rounded opacity abutting the thickened pleura with a 'comet tail' sign extending into the parenchyma. What is the most likely diagnosis?
- A Malignant pleural mesothelioma
- B Pleural fibroma (solitary fibrous tumour)
- C Rounded atelectasis (Blesovsky's syndrome) ✓
- D Peripheral lung carcinoma with pleural invasion
Explanation
Rounded atelectasis (Blesovsky's syndrome) is a distinctive form of lung collapse associated with pleural disease, characteristically seen in asbestos-related pleural disease. CT shows a rounded/ovoid pulmonary mass abutting the pleura, with curvilinear bronchovascular structures sweeping into its edge (comet tail or crow's feet sign), pleural thickening/effusion, and volume loss in the adjacent lobe. The mass rotates and folds into itself as the pleura thickens. It is benign and stable, distinguishable from carcinoma by the comet tail sign and association with pleural abnormality. CT enhancement is minimal and no biopsy is required if features are classic.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.