Pleural tumour and effusion

Case contributed by Dr Wayland Wang

Presentation

Chest pain.

Patient Data

Age: 80
Gender: Male

Chest x-ray

Modality: X-ray
There is extensive pleural opacity on the left encasing the lung and extending onto the mediastinal surface typical for malignant pleural disease. The opacity extends to the mid thorax level with a meniscus indicating at least some fluid however the relative amounts of solid tumour vs pleural fluid cannot be determined by plain film. Interstitial opacity is seen in the remaining aerated lung in the left upper zone. The right lung and pleural space are clear. The cardiomediastinal contours are obscured on the left.

Case Discussion

On further questioning of the patient's history it was discovered that there is a past history of mesothelioma, which would fit with this appearance of pleural tumour encasing the left lung. Pleural thickening that extends onto the mediastinum should always be regarded with suspicion. Other clues that may be helpful include calcified pleural plaques indicating asbestos exposure, missing ribs indicating either metastases or previous surgery, and surgical clues such as an absent breast shadow, axillary surgical clips, etc.
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Case Information

rID: 50751
Case created: 20th Jan 2017
Last edited: 21st Jan 2017
System: Chest
Inclusion in quiz mode: Included

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