Presentation
Breathlessness.
Patient Data
Left hemi-thorax white-out. Tracheal and mediastinal deviation to the right. Calcified pleural plaques on the right. No focal right lung lesion.
The patient under thoracentesis.
Left pleural effusion has been partially drained. Small left pneumothorax with incomplete re-expansion of the left upper lobe, which demonstrates peripheral increased density. Left sided pleural plaques are now seen.
Small right and moderate left pleural effusions. The left pleural effusion is loculated with nodular peripheral enhancement. Bilateral calcified pleural plaques. Small left pneumothorax.
The left lung has partially reinflated with a large lower lobe mass. No suspicious pulmonary nodule within the right lung.
Hilar, mediastinal, internal mammary and epicardial lymphadenopathy.
Thoracic kyphoscoliosis T8 crush fracture.
Enlarged lymph node at the celiac axis. Numerous small hepatic hypodensities are non-specific but could represent metastases (particularly liver segment 7 with peripheral enhancement) and/or cysts.
Case Discussion
The CT demonstrates metastatic disease, the epicenter of the disease is the left pleural space (including the pleural effusion, which are common), which in combination with the calcified pleural plaques makes mesothelioma the most likely primary - these clues are present on the presentation x-ray and on the post-thoracentesis x-ray incomplete expansion of the left apex with the peripherally density represents lung entrapment. Histology results are not available for this patient.
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