An asymptomatic 75-year-old man was referred to our hospital because multiple nodular shadows were found on chest X-ray films before inguinal hernia surgery. Chest computed tomography (CT) showed multiple nodules with an extra-pleural sign that extended into the interlobar fissure. The result of cytological examination of the percutaneous pleural biopsy with ultrasonography was class V, and malignant mesothelioma was strongly suspected. Video-assisted surgery (VATS) was therefore performed, and that confirmed biphasic malignant mesothelioma based on histopathological and immunohistochemical analysis. The most common presenting manifestation of malignant mesothelioma on chest images is unilateral pleural effusion. Other manifestations include nodules and diffuse pleural thickening. However, multiple nodules without pleural effusion and diffuse pleural thickening on a chest CT can be rare findings of malignant mesothelioma. Our case alerts us to consider the diagnosis of malignant mesothelioma in such radiographic findings.