64-year-old male with a history of malignant pleural mesothelioma status post pleurectomy/decortication surgery LUNGS AND PLEURA: Note is made of multiple foci of restricted diffusion consistent with active disease. There is a focus of restricted diffusion corresponding to the pleural thickening along the left anterior upper lobe (series 608; image 432). There is associated enhancement on postcontrast sequences. Note is made of 2 additional foci of restricted diffusion corresponding to pleural thickening along the posterior aspect of the left lower lobe also consistent with active disease (image 96 and image 80 of series 608). There is associated enhancement on postcontrast sequences. Multiple additional foci of increased T2 signal abnormality and peripheral enhancement are identified along the paramediastinal pleura on the left corresponding to pleural thickening seen on prior CT examination, however, there is no restricted diffusion to suggest active disease. These findings likely represent postinflammatory change.Trace bilateral pleural effusions.MEDIASTINUM AND HILA: There is an additional focus of restricted diffusion corresponding to the left intercostal nodes seen adjacent to the body of the sternum on prior CT examination (image 304; series 608). There is associated pathologic enhancement on postcontrast sequences.CHEST WALL: Note is made of postsurgical changes consistent with the stated history of prior cytoreductive surgery. Right chest port tip terminates at the cavoatrial junction.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia.
1. Multiple foci of restricted diffusion with associated enhancement consistent with active disease/mesothelioma corresponding to pleural thickening along the anterior aspect of the left upper lobe and posterior aspect of the left lower lobe. There is also restricted diffusion corresponding to the previously described left intercostal nodes seen on prior CT examination suspicious for metastatic disease.2. Foci of abnormal enhancement and pleural thickening along the paramediastinal and posterior aspect of the left lower lobe do not demonstrate restricted diffusion and likely represent postinflammatory change rather than active disease.