Imaging

Mesothelioma

Preliminary Diagnosis: Mesothelioma

I. What imaging technique is first-line for this diagnosis?

  • Chest x-ray, PA and lateral view

II. Describe the advantages and disadvantages of this technique for diagnosis of mesothelioma.

Advantages

  • Highly portable and fast imaging modality.

  • Exposes the patient to minimal ionizing radiation.

  • Relatively inexpensive imaging modality.

Disadvantages

  • Less sensitive and specific in detecting and detailing the pulmonary pathology and extent of the lesion than cross sectional imaging

  • Less adept in detecting any underlying primary parenchymal or pleural abnormality or secondary complication than cross sectional imaging

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.

IV. What alternative imaging techniques are available?

  • CT of the chest with intravenous contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesothelioma.

CT of the chest with intravenous contrast

Advantages

  • Gold standard imaging modality to diagnose and characterize mesothelioma

  • Able to exquisitely detail the extent of the mesothelioma and any secondary complications

  • More adept in staging mesothelioma

  • May help guide treatment and biopsy

Disadvantages

  • Exposes the patient to more ionizing radiation compared with plain radiography

  • Less portable

VI. What are the contraindications for the alternative imaging techniques?

CT of the chest with intravenous contrast

  • May be contraindicated in pregnant patients

  • Intravenous contrast is relatively contraindicated in patients with elevated creatinine (institution dependent) and/or patients not on an adequate and acceptable dialysis regimen in relation to contrast administration

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