Clinical and radiologic features

Diffuse malignant pleural and peritoneal mesothelioma often have an insidious onset and patients frequently present with nonspecific symptoms. Patients with diffuse mesothelioma are most commonly adult men presenting with dyspnea and chest pain (pleural mesothelioma), abdominal distension (peritoneal mesothelioma), and signs and symptoms associated with third-spacing, namely pleural effusions and/or ascites. The interval between symptoms and diagnosis is typically 2-3 months, but can be several months to years. Such insidious behavior can progress rapidly and aggressively, posing several challenges both clinically and radiologically. This chapter addresses the clinical and radiological characteristics of this disease emphasizing conventional wisdom and practices. Newer techniques for detecting early disease, enhancing staging and prognostic accuracy, and providing targeted individualized treatment are also briefly described.