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Mesothelioma

Case contributed by Paul Leong
Diagnosis almost certain

Presentation

Fall. Query rib fracture.

Patient Data

Age: 80 years
Gender: Male
x-ray

Lobulated pleural opacity encasing the right lung, with associated volume loss.

No definite bony erosion / destruction or calcified pleural plaques seen. 

ct

Lobulated pleural soft tissue mass, encasing the right lung.

Associated erosion of the right 3rd rib anteriorly.

Calcified pleural plaques noted bilaterally, indicating previous asbestos exposure. 

Case Discussion

Appearances are typical of pleural mesothelioma, especially given the evidence of underlying asbestos-related pleural disease.

Differentials to consider would be pleural metastasis or invasive thymoma with pleural spread (although these would be much less likely in this particular case).

CT guided biopsy of the pleural mass was performed, confirming malignant mesothelioma. 

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