Formerly considered to be rare, primary malignant mesothelioma of the pleura has become a frequently diagnosed tumor during the last 30 years because of a more specific diagnostic criteria and because of its relationship with asbestos exposure. The radiologic findings associated with malignant mesothelioma of the pleura are not patho- neumonic but are characteristic and include a unilateral pleural effusion, unilateral pleural thickening, rib destruction and infra diaphragmatic spread, pulmonary nodules and masses and in distant metastases. These findings are in addition to the associated changes related to asbestos exposure. A review of the clinical records and radiographs of 26 patients with proven malignant mesothelioma studied at our institution serves as the basis for this review. The differential diagnosis radiologic findings and the relationship between these changes and the pathology clinical picture and the prognosis in this important disease entity is discussed.