Pleural Mesothelioma

Epidemiology

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Etiology

  • Asbestos exposure:
  • Idiopathic: 33% of cases have minimal or no asbestos exposure

Diagnosis

  • Chest CT
  • PET Scan: sensitive for detection of mediastinal/hilar nodes

Pleural fluid:
-pH:
-LDH ratio:
-Total protein ratio:
-Glucose:
-Cell count/diff:
-Cholesterol: elevated >55-60 mg/dL (seen in all exudates)
-Pleural: serum cholesterol ratio: elevated (seen in all exudates)

CXR/Chest CT Patterns:
1) Pleural effusion: present in most mesothelioma cases
-However, sarcomatous cell type may have small or no pleural effusion
2) Pleural thickening with encasement of lung: may involve the mediastinal pleura (mediastinal pleural involvement is uncommon in benign pleural diseases)


Clinical

  • Chest wall pain: this distinguishes it from fibrothorax, where chest pain is rare
  • Dyspnea:
  • Weight loss:

Treatment

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References

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