Presentation
Increasing SOB.
Patient Data
A multi lobulated pleural based mass almost completely encases the right lung. Moderate right lung volume loss is present. Left lung and pleural spaces are clear apart from a small focus of subsegmental atelectasis basally. Heart and mediastinum are normal.
Multiple irregular nodular pleural based soft tissue density masses in the right hemithorax with extension into the diaphragmatic and mediastinal pleura as well as the fissures. Small loculated pleural effusion inferiorly on the right.
Small soft tissue density nodule in the apical segment of the left lower lobe.
Area of consolidation in the left lower lobe anterolaterally. No left pleural effusion.
No pericardial effusion. There are several borderline lymph nodes in the pretracheal region and aortopulmonary window.
The liver is normal in density. No focal lesion. Calcified granulomas in the spleen.
Impression
Pleural based nodular soft tissue masses engulfing the right lung with associated pleural effusion. Differential diagnosis is of primary or secondary pleural malignancy. The left lower lobe nodule may be a metastasis.
Case Discussion
Biopsy revealed pleural epithelioid angiosarcoma, which is a rare aggressive malignancy of vascular differentiation unrelated to asbestos exposure 1. The tumor more commonly arises in the skin, liver, spleen and heart and has a high mortality despite aggressive surgical and chemotherapeutic management. Possible risk factors include prior TB infection and chest radiation.
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