Computed tomographic assessment of patients following radical surgery for malignant mesothelioma

Serial computed tomographic (CT) scans of the thorax and upper abdomen were performed in eight patients following radical surgery (pleuro-pneumonectomy) for diffuse malignant mesothelioma of the pleura. The post-operative appearances included a well defined membrane lining the pleuro-pneumonectomy space in seven cases; in two cases this resembled the original tumour. In six patients there was upward abdominal visceral displacement on the side of the surgery due to diaphragmatic resection; this resulted in contralateral mediastinal shift in four patients. One patient required a diaphragmatic prosthesis which produced a distinctive CT appearance. CT suggested recurrent mesothelioma in five cases. Although two patients had evidence of intrathoracic recurrence, in three patients the only feature was the non-specific finding of abdominal ascites. The normal CT appearances after pleuro-pneumonectomy should be recognized to facilitate radiological interpretation. With careful application CT is of value for the assessment of recurrent disease in patients following radical surgery for malignant mesothelioma.