Pleural based mass

Case contribution: Dr Radhiana Hassan


  • A 23 years old man
  • History of right testicular carcinoma
  • Orchidectomy and completed chemotherapy about one year ago
  • Presented with occasional chest discomfort and cough
Chest radiograph PA erect view

Radiograph findings:

  • A huge mass seen in the left thoracic region (yellow arrows)
  • Peripherally located with obtuse margin
  • No fluid levels or calcification within it
  • No obvious adjacent ribs destruction
  • No pleural effusion or pneumothorax.
  • No hilar mass. No cardiomegaly. No mediastinal widening
Contrast enhanced CT thorax in axial planes soft tissue and lung windows

CT scan findings:

  • A large pleural based mass is observed at the left hemithorax measuring about 9.9 x 6.5 x 9.2cm (AP x W x CC).
  • It appears heterogeneously hypodense, with multiple enhancing solid component observed. Internal septations are also seen within the mass.
  • No erosion of the adjacent ribs noted.
  • Another round hypodense nodule is also seen in the left lung base (image not shown)
  • No pleural effusion is detected bilaterally.
  • No enlarged mediastinal node. Shotty nodes are observed in both axillary regions.

Diagnosis: Metastatic pleural based mass.


  • Differential diagnosis of pleural based mass include pleural tumours, metastatic pleural disease, loculated fluid, mass related to chest wall or ribs, mass related to intercostal nerve and infection.
  • Metastatic pleural disease are particularly from adenocarcinoma from bronchogenic carcinoma, ovarian cancer, breast cancer, prostate cancer, GI adenocarcinoma and renal cell carcinoma.
  • Pleural metastases are more common than malignant mesothelioma.
  • Pleural metastasis usually affect the visceral and parietal pleura.
  • Pleural effusion almost always occurs due to impaired lymphatic drainage or capillary permeability increased by inflammation or rupture or endothelium

Progress of patient:

Repeat chest radiograph after 3 months
  • Worsening of lung metastasis and the pleural based lesion grew bigger
  • Left thoracotomy with excision of tumour, lower lobectomy and non-anatomical resection of lingula and posterior subsegmentectomy of apipoposterior segment with phrenectomy done
  • Repeat CT scan shows an air-filled left hemithorax with small residual aerated left lung (possibly posterior segment of the left upper lobe) are in keeping with post-operative changes. No evidence of recurrence
Post operation CT scan
Author: radhianahassan