History of malignant mesothelioma in the right hemithorax status post pleurectomy and decortication. Epithelioid subtype. Presents for MRI evaluation of new left pleural effusion with nodularity on recent CT. LUNGS AND PLEURA: Postsurgical changes of the right lung base with moderate atelectasis and minimal pleural fluid. There is a small left pleural effusion as seen on the recent CT. There are left sided small pleural plaques. There are several small foci of subtle restricted diffusion and questionable foci of linear enhancement on post-contrast imaging in the left pleural space. No discrete measurable sites of disease are identified in the left hemi-thorax.Left lung base pleural enhancement is present and may be reactive to the pleural effusion. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Numerous nonspecific right greater than left subcentimeter axillary and anterior abdominal wall lymph nodes.UPPER ABDOMEN: The upper abdomen is partially imaged. A large right renal cyst is partially seen.
Suspicious but not conclusive evidence of tumor involvement of the left hemi-thorax, including several small foci of subtle restricted diffusion and questionable foci of post-contrast enhancement in the left pleural space but no discrete measurable sites of disease are identified in the left hemi-thorax. Stable non-specific small left pleural effusion and pleural enhancement which may be reactive. A follow-up surveillance MRI examination may be of value to assess the evolution of these findings.