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Ann Thorac Surg 2002;73:665
© 2002 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Malignant mesothelioma with osseous differentiation

Hon Chi Suen, MBBS*a, Barbara Sudholt, MDb, Wallace M. Anderson, MDc, Mazhar H. Lakho, MDb, Bill B. Daily, MD, PhDa

a Department of Cardiothoracic Surgery, Memorial Hospital, Belleville, Illinois, USA
b Department of Medicine, Memorial Hospital, Belleville, Illinois, USA
c Department of Radiology, Memorial Hospital, Belleville, Illinois, USA

* Address reprint requests to Dr Suen, Cardiothoracic Surgery Associates, S.C., 12B Park Pl, Swansea, IL 62226, USA
e-mail: hsuen{at}earthlink.net

An 80-year-old man with a history of prolonged asbestos exposure presented with left-sided chest pain. Chest film showed a left pleural effusion with pleural calcification that had not been present on a film taken after coronary artery bypass surgery 2 years previously (Fig 1). Computed tomographic scan confirmed a large effusion surrounded by a thickened, calcified pleura (Fig 2). Serum alkaline phosphatase was markedly ele-vated. A technetium bone scan showed marked uptake of isotope in the left pleura (Fig 3, anterior view; Fig 4, posterior view) with no evidence of distant bony metastasis. Attempted left thoracentesis and thoracoscopy failed because neither the needle nor the trocar could penetrate the calcified pleura. Rib resection and open pleural biopsy revealed a malignant mesothelioma with osseous differentiation. The patient died 4 months later. Only 15 cases of malignant mesothelioma with osseous differentiation have been described in the literature, and bone scan pictures of this pathology have never been presented before.



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