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case_images: Mediastinal windows of computed tomography (A and B) confirm the previously noted bilateral pleural thickening, calcification. There is associated left lobe Pleural effusion and atelectasis.
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case_images: Chest computed tomography (CT) showed diffuse thickening and calcification of the pleura on both sides, pleural effusion and atelectasis on the left side (Figure 1A and B).
case_images: Right lung branch pulmonary embolism, mainly involved pulmonary artery (arrow).
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case_images: Then, the computed tomography pulmonary angiography (CTPA) was performed for the patient, and the results showed that there was embolism in the right pulmonary artery branch (Figure 2).
case_images: Mediastinal windows of computed tomography (A and B) revealed pleural effusion on the left side.
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case_images: However, after being discharged from the hospital, the patient was still admitted to the hospital several times due to chest pain and dyspnea, and the reexamined chest CT still showed a large amount of pleural effusion on the left side (Figure 3A and B).
case_images: PET-CT suggests thickening and calcification of the pleura on both sides, increased FDG metabolism, more pronounced on the left.
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case_images: FDG metabolism was increased, and malignant tumors were considered (Figure 4).
case_images: Ultrasound guided biopsy specimen from tumor lesions. Fibroblast-like spindle cells arranged in bundles or chaotically, the tumor cells had obvious atypia, mitotic figures, and coagulative necrosis. ((A and B), hematoxylin-eosin).
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case_images: Later, the patient underwent an ultrasound-guided pleural biopsy, and the pathological examination revealed fibroblast-like spindle cells arranged in bundles or chaotic shapes (Figure 5A and B).
case_images: Immunohistochemical staining (20 X) revealed WT-1 positivity (A), GATA-3 positivity (B) and CK (pan) positivity (C).
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case_images: HMB45(Melanoma)(-), MyoD1(-), Caldesmon(-), D2-40(-), CEA(-), Vimentin(-) (Figure 6). Combined with the above examination results, the final diagnosis was sarcomatoid pleural mesothelioma. However, two days later, the patient suddenly developed a coma, facial cyanosis, and sudden cardiac arrest.