CT chest of a 62-year-old man with progressive breathlessness and unilateral chest pain shows circumferential nodular pleural thickening exceeding 1 cm involving the mediastinal pleura, encasing the lung with volume loss, and extending into the major fissure. The most likely diagnosis is:

• A Empyema
• B Simple asbestos-related pleural plaques
• C Malignant pleural mesothelioma ✓
• D Pleural metastases from breast carcinoma

Explanation

Circumferential pleural thickening greater than 1 cm, mediastinal pleural involvement, nodularity and associated ipsilateral volume loss are the CT features that favour malignant mesothelioma over benign asbestos-related pleural disease. Benign plaques are discrete, bilateral, spare the mediastinal pleura and cause no volume loss. Empyema is unilateral but lenticular with enhancement and no circumferential nodular rind, and breast metastases usually produce multiple smaller pleural deposits with effusion.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.