A fatal asbestos-related cancer, malignant mesthelioma originates from the lining cells (mesthelium) present in the pleural and peritoneal cavities, and also in the pericardium and the tunica vaginalis. A precise rate of prevalence is not known, but estimates indicate that occurrence of mestheliomas is less than 1% of all known forms of cancer. The incidence rate of mestheliomas is on the rise and it is anticipated that it will peak in the coming 10-20 years time frame. The most commonly occurring form of mesthelioma is pleural malignant mesthelioma. The presenting features are usually chest pain and dyspnoea. Breathlessness (without chest pain) resulting from pleural effusion also occurs in approximately 30% of patients. Less common presentations include weight loss, a chest wall mass, abdominal pain, sweating, and ascites (resulting from peritoneal involvement). In more then 90% of cases, the occurrence of mesthelioma is directly related to a history of occupational asbestos exposure. Available evidence also shows that mesthelioma can occur due to both para-occupational exposure and “environmental” (non-occupational) exposure. There have also been instances of idiopathic and spontaneous mesthelioma that occur without any exposure to asbestos. These have a spontaneous rate of about one per million in humans. To make a diagnosis, it is essential to use a combination of an accurate history of asbestos exposure and radiology and pathology examination. It is a challenge to differentiate between malignant and benign pleural disease. Some of the CT findings that help indicate presence of pleural disease include – 1) nodular pleural thickening, 2) a circumferential pleural rind, 3) mediastinal pleural involvement, and 4) pleural thickening of less than 1 cm. It is recommended that a multidisciplinary team be involved to facilitate efficient and appropriate management, based on an effective combination of radiotherapy, chemotherapy, surgery, and symptom palliation supported by end of life care. Life expectancy is poor in case of malignant mesthelioma; the median survival being one year after the diagnosis is made.