iatroX Rounds #21
The clues
- 1
A 72-year-old man presents with a progressive, dull ache on the right side of his chest and increasing breathlessness over several months.
- 2
The chest pain is persistent, non-pleuritic in nature and is associated with a dry cough and unintended weight loss.
- 3
He spent his career as a boiler engineer and shipbuilder in the 1970s, often working in dusty environments with lagged pipes.
- 4
Physical examination reveals stony dullness to percussion and absent breath sounds at the right lung base.
- 5
A chest X-ray shows a large unilateral pleural effusion and associated nodular thickening along the pleural surface.
- 6
Computed tomography of the chest demonstrates a circumferential pleural rind that involves the mediastinal pleura and extends into the interlobar fissures.
<p><strong>Mesothelioma</strong> is a primary malignancy of the pleura, or less commonly the peritoneum, with a strong causal link to historical <strong>asbestos exposure</strong>. The clues reflect its characteristic presentation with progressive breathlessness and persistent chest wall pain due to the tumour encasing the lung, typically appearing 20 to 40 years after exposure.</p>
- History of industrial asbestos exposure in shipbuilding, plumbing or construction
- Persistent, dull, non-pleuritic chest wall pain
- Recurrent or large unilateral pleural effusions
- Weight loss and constitutional symptoms
for education and entertainment. not medical advice.