Figures
- FIGURE 1
Ultrasound demonstrating large echoic effusion (A) above a flattened diaphragm (B) with extensive thick, irregular nodularity arising from the diaphragm (C) and visceral pleural (D). This is highly suspicious for malignancy, most likely malignant pleural mesothelioma.
- FIGURE 2
FDG (18-fluoro-deoxy-glucose)-positron emission tomography showing malignant pleural mesothelioma. A: an area of high FDG uptake (maximum standardised uptake value of 13.4) in the left lateral pleura beneath the third rib. B: a right paratracheal lymph node with maximum standardised uptake value of 4.6.
- FIGURE 3
Flowchart demonstrating the decision making process for investigating and managing pleural effusions in malignant pleural mesothelioma. IPC: indwelling pleural catheter; CXR: chest radiograph.
- FIGURE 4
Talc poudrage seen at thoracoscopy. A: parietal pleura with ribs visible beneath and a fine layer of talc covering most of its surface. B: malignant-looking nodule on the parietal pleura. C: collapsed lung with talc covering its surface. D: talc collecting in the para-spinal gutter.
Tables
- TABLE 1
The International Mesothelioma Interest Group Staging System for malignant pleural mesothelioma
T T1 Tumour of the ipsilateral parietal pleura, including diaphragm and mediastinal pleura T1a No visceral pleural involvement T1b With visceral pleural involvement T2 Tumour affecting parietal, visceral, diaphragmatic and mediastinal pleura, with either involvement of diaphragmatic muscles or pulmonary parenchyma T3 Involvement of the endothoracic fascia, extension into the mediastinal fat, non-transmural involvement of the pericardium or resectable focus of chest wall invasion T4 Unresectable disease, diffuse chest wall or mediastinal involvement, direct transdiaphragmatic spread into the peritoneum, contralateral plural involvement, invasion of the spine, ribs or brachial plexus, trans-mural pericardial invasion or malignant pericardial effusion N N0 No regional lymph node metastases N1 Metastases in ipsilateral bronchopulmonary or hilar lymph nodes N2 Metastases in subcarinal or ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary chain N3 Contralateral lymph node metastases, ipsilateral or contralateral supraclavicular lymph node involvement, and scalene nodes M M0 No extrathoracic metastases M1 Extrathoracic metastases present Reproduced from [41] with permission from the publisher.
