Malignant Mesothelioma Versus Metastatic Adenocarcinoma of Pleura: A Comparison CT Study


Ghazaleh Amjad 1 , * , Shahram Kahkouee 2 , Ali Emadoddin 2

1 Department of Radiology, Tehran University of Medical Sciences, Tehran, IR Iran

2 Department of Radiology, Masih-e-Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

How to Cite: Amjad G, Kahkouee S, Emadoddin A. Malignant Mesothelioma Versus Metastatic Adenocarcinoma of Pleura: A Comparison CT Study, Iran J Radiol. Online ahead of Print ; 11(30th Iranian Congress of Radiology):e21271. doi: 10.5812/iranjradiol.21271.


Iranian Journal of Radiology: 11 (30th Iranian Congress of Radiology); e21271
Published Online: February 28, 2014
Article Type: Research Article


Background: Malignant mesothelioma and metastatic adenocarcinoma are the two most common pleural malignancies. They have similar imaging findings but different prognosis and treatment. CT scan is the modality of choice for their diagnosis.

Objectives: In this study, details of chest CT findings in these two conditions were assessed to find out if there are any imaging clues for early differentiation.

Patients and Methods: Chest CT scan of 113 patients [metastatic adenocarcinoma: 58 (52%) and malignant mesothelioma: 55 (48%)] were retrospectively reviewed by two radiologists with consensus at Masih Daneshvari University Hospital Medical Center, Tehran, Iran between 2005 to 2010. Patients were assessed for 35 CT variables and smoking and occupational history.

Results: History of asbestos exposure was detected in 96% of cases of malignant mesothelioma. As for malignant mesothelioma related CT findings, pleural plaques and calcifications were detected in 92% and 89% of cases, respectively. On the other hand, pulmonary mass (23%), nodules (34%), interstitial reticulation, and interlobular septal thickening (lymphangitic carcinomatosis) (15%) were in favor of metastatic adenocarcinoma. Invasion to chest wall and lobar fissure were more common in malignant mesothelioma (23% vs. 15%), while bony metastasis and mediastinal lymphadenopathy were more frequent in metastatic adenocarcinoma (18% vs. 12%). Pleural effusion in malignant mesothelioma was mostly loculated and unilateral (73%), in contrast with metastatic adenocarcinoma in which it was mostly bilateral (65%). There were no significant differences in terms of age, sex, history of smoking, extent of pleural and pericardial effusion, pleural thickening, and involvement of mediastinal pleura between malignant mesothelioma and metastatic adenocarcinama.

Conclusions: Malignant mesothelioma needs to be distinguished from metastatic adenocarcinoma. These pleural tumors have different treatments and prognoses. CT scan is a primary and good imaging technique that can be used in order to differentiate these two entities. Albeit non-identical, CT appearances of malignant mesotheliomas and metastatic adenocarcinomas have similar features. Using a check list containing the mentioned diagnostic CT features can be helpful in differentiation between these two diseases.

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