HISTORY: A 58-year-old man who had worked on asbestos-lined furnaces 40 years ago presented to his physician with a history of multiple episodes of exertional dyspnea over the past year. Over the past 6 months, the patient had three pleural effusions drained on the left side with unremarkable results at cytologic analysis. He also reported weight loss of about 10 lb (4.5 kg) over the previous 4-6 months. Physical examination demonstrated decreased breath sounds on the left side with dullness to percussion. Laboratory data were unremarkable.
IMAGING FINDINGS: Initial chest radiography and chest computed tomography (CT) demonstrated circumferential, lobulated pleural thickening involving the left lung with associated left lung volume loss (Figs 1,2). Whole-body integrated positron emission tomography (PET)-CT demonstrated circumferential pleural thickening surrounding the entire left lung with significant hypermetabolic glucose activity consistent with tumor. PET-CT also showed hypermetabolic tumor foci invading the pulmonary parenchyma. No evidence of chest wall or mediastinal invasion was seen and no distant metastases were identified (Fig 3).