Chest ImagingLocalized fibrous neoplasm, pleura
(also called
pleural fibroma,
benign mesothelioma, fibrous mesothelioma and localized
pleural mesothelioma),
tumour that arises from mesenchymal cells within the
pleura with a histological spectrum from
benign to
malignant. There is an equal sex incidence. Most patients are over 40 years and asymptomatic, with the
tumour presenting as an incidental finding on a chest radiograph. Occasionally there may be symptoms of cough, chest pain, dyspnoea and of hypoglycaemia. There may be finger clubbing and
hypertrophic osteoarthropathy. There is no relation to asbestos exposure.
On chest radiography the appearance is that of a well defined, occasionally lobulated mass which is often very large when first detected. Occasionally the tumour arises from a pedicle and there may be a change in position or shape with different postures or phases of respiration. The pleural origin of the lesion may not be obvious, particularly when it is large.
On CT the appearance is of a homogeneous soft tissue mass which enhances with intravenous contrast medium (Fig.1). Large lesions often contain central areas of low attenuation due to necrosis. The pleural origin of the lesion can usually be established with CT and occasionally the tumour may arise from or within a fissure. A stalk may be visible. Calcification of the tumour and associated pleural effusions are not common. There may be local extension into soft tissue or bone destruction with the more malignant varieties. On MR imaging, the tumour is iso- or hypointense on T1-weighted images, hyperintense on T2-weighted images and enhances after administration of gadolinium.
CF - HM
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Transaxial nonenhanced CT image of a large left localized fibrous neoplasm of the pleura containing some areas of low attenuation due to necrosis.
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Localized fibrous neoplasm, pleura, Fig.1 | |