1. Case of the Month 26 August 2017
History:
60 year old man with cough, pleuritic chest pain and low grade pyrexia

2. Case of the Month 26

3. Case of the Month 26
What is your diagnosis ?

5. Case of the Month 26 August 2017
History:
60 year old man with cough, pleuritic chest pain and low grade pyrexia
Question:
What are the key findings on the CXR?
Authors: DJ Murphy, JD Dodd,
St Vincent’s University Hospital, Dublin, Ireland

6. Case of the Month 26
Large right sided pleural effusion

7. Case of the Month 26
Question:
What are the key findings on CT?

8. Case of the Month 26
Asymmetric right-sided mediastinal pleural thickening (arrow)
Anterior to the anterior cortex of the vertebral bodies
Large right sided pleural effusion

9. Case of the Month 26
What is your differential diagnosis?

10. Malignant mesothelioma
Case of the Month 26
Diagnosis
Differential Diagnosis
Pleural malignancy
TB pleuritis
Diagnosis
Pleural Malignancy
Typically either:
Malignant mesothelioma
Pleural metastasis

11. Discussion Case of the Month 26
Key features that help distinguish malignant from benign pleural disease:
Circumferential pleural thickening
Nodular pleural thickening
Pleural thickening >1cm
Mediastinal pleural involvement
Cannot reliably distinguish pleural metastases from malignant mesothelioma
Requires VATS biopsy for definite diagnosis of mesothelioma, core biopsy is not sufficient
Not accurate if previous thoracic or cardiac surgery

12. Further Reading Case of the Month 26 Pleural Malignancy
Leung AN, Muller NL, Muller RR (1990). CT in the differential diagnosis of diffuse pleural disease. AJR 154:
Nickell LT, Lichtenberger JP, Khorashadi L et al (2014). Multimodality imaging for the chracterisation, classification and staging of malignant pleural mesothelioma. Radiographics 34:6,
Halifax RJ, Haris M, Corcoran J et al (2014). Role of CT in assessing pleural malignancy prior to thoracoscopy. Thorax doi: /thoraxjnl
Porcel JM, Pardina M, Biesla S et al (2015). Derivation and validation of a CT scan scoring system for discriminating malignant from benign pleural effusions. Chest 147(2):