A 58-year-old shipyard worker with a 30-year asbestos exposure history presents with dyspnea. CT chest shows bilateral, irregular, pleural-based masses with circumferential pleural thickening extending into the fissures. Which diagnosis is most likely?
- A Malignant mesothelioma ✓
- B Pleural effusion secondary to congestive heart failure
- C Metastatic adenocarcinoma to the pleura
- D Empyema necessitans
Correct answer: A. Malignant mesothelioma
Explanation
Malignant mesothelioma is strongly associated with asbestos exposure and characteristically shows bilateral, irregular, pleural-based masses with circumferential pleural thickening that extends into the fissures. Congestive heart failure causes bilateral free-flowing pleural effusions without pleural thickening. Pleural metastases are usually unilateral and associated with parenchymal masses. Empyema necessitans is a chronic pleural infection with sinus tract formation, not diffuse pleural thickening.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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