What are the key clinical features and risk factors to consider when suspecting mesothelioma in a patient?

Key clinical features to consider when suspecting mesothelioma include persistent unilateral pleuritic chest pain, progressive dyspnoea, and a history of pleural effusion often detected on imaging. Patients may also present with weight loss, fatigue, and a dry cough. On examination, reduced breath sounds and signs of pleural thickening or effusion may be evident. These symptoms are typically insidious and progressive, reflecting the diffuse involvement of the pleura Rusch 1995Mineo & Ambrogi 2012Mencoboni et al. 2017 NICE NG12.

Risk factors are dominated by a history of asbestos exposure, which remains the primary and most significant risk factor for malignant pleural mesothelioma. This exposure may have occurred occupationally, environmentally, or through secondary contact. The latency period between asbestos exposure and disease onset is often several decades. Other risk factors include male sex, older age, and possibly genetic predisposition, although these are less definitive Rusch 1995Mineo & Ambrogi 2012Mencoboni et al. 2017 NICE NG12.

In summary, when suspecting mesothelioma, clinicians should focus on a combination of characteristic clinical features such as persistent unilateral chest pain and pleural effusion, alongside a detailed occupational and environmental history to identify asbestos exposure, which is the critical risk factor driving suspicion and subsequent referral for further diagnostic evaluation NICE NG12.