Chest Medicine













Malignant mesothelioma
  • Tumour of the mesothelial cells of the pleura (rarely in the peritoneum and other organs)
  • Complex association with asbestos exposure (unlike asbestosis)
  • 90% of patients reported prior exposure (note recall bias) whilst only 20% showed features of asbestos-related lung disease
  • Latent period between asbestos exposure to mesothelioma may be up to 45 years

Signs and Symptoms
  • Symptoms: dyspnoea, weight loss, chest pain
  • Signs: digital clubbing, recurrent pleural effusions, lymphadenopathy, hepatomegaly
  • If metastasis: bone pain, abdominal pain/obstruction

Investigation
  • CXR showing pleural thickening
  • CT chest

    Coronal reformat of a CT of the chest in a patient with left sided mesothelioma. Note the extensive pleural mass with contraction of the left hemithorax. This image is from the full mesothelioma case at Radiopaedia.org (courtesy of Frank Gaillard)

  • Pleural fluid aspiration
  • Thoracoscopy: provides histological diagnosis

Management
  • Chemotherapy may improve survival
  • Mixed evidence regarding radiotherapy
  • Pleurodesis and chest drain for effusions

Reference: Oxford Handbook of Clinical Medicine (10th Edition)