Case contributed by Dr Hani Makky Al Salam


Left sided pleural effusion for evaluation. Possible asbestos exposure.

Patient Data

Age: 65
Gender: Male

Very subtle left sided pleural thickening is seen.


Five years later the patient presented with large left sided pleural effusion.


Large left sided pleural effusion associated with left pleural thickening. Multiple few millimeteric lung nodules and medistinal lymph nodes are seen.

Nuclear medicine

PET scan shows mild diffuse FDG uptake of the left thickened pleura. 

Case Discussion

Patients presented with pleural effusions associated with pleural thickening , the cause most probably fall in the neoplastic category especially if the thickening is nodular. The differential diagnosis of pleural thickening would include benign entities such as recurrent inflammation, recurrent pneumothoracies, seqaule of empyema or hemothorax and could be related to occupational or inhalational diseases such as asbestosis or silicosis. On the other hand, malignancy should be suspected if the pleural thickening is nodular or it is associated with pleural effusion. The differential diagnosis would include, primary neoplastic processes like mesothelioma, lymphoma and invasive thymoma or  secondaries from bronchogenic , breast, prostate, ovarian, gastrointestinal or renal cell carcinomas. Thoracic splenosis is a rare cause of plural nodular thickening.

Left pleural biopsy reveled invasive malignant neoplasm consistent with mesothelioma, epithelioid type.

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