Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor that arises from the pleura. A previous exposure to asbestos is the main risk factor of mesothelioma. Clinical signs are mostly late and unspecific. Chest CT shows unilateral pleurisy associated with pleural nodular thickening and tumor invasion of adjacent structures. The diagnosis of MPM is based on histology using immunohistochemistry on pleural biopsies best obtained by thoracoscopy. The treatment of MPM relies mainly on chemotherapy. Surgery, pleurectomy/decortication or extrapleural pneumonectomy is rarely undertaken as a result of staging of tumor. This article shows that CT has an essential role in the diagnosis, assessment and monitoring response to therapy of patients with malignant pleural mesothelioma.