Summary
Definition
History and exam
Key diagnostic factors
- family history
- history of asbestos exposure
- age between 60 and 85 years
- shortness of breath
- diminished breath sounds
- dullness to percussion
Other diagnostic factors
- male sex
- chest pain
- cough
- constitutional symptoms
- abdominal distention and/or pain
Risk factors
- asbestos exposure
- age 60 to 85 years
- asbestos exposure during home maintenance and renovation
- male sex
- radiation exposure
- genetic predisposition
- simian virus 40 (SV-40)
Diagnostic tests
1st tests to order
- CXR
- CT chest and upper abdomen (with contrast)
Tests to consider
- thoracentesis
- pleural biopsy
- video-assisted thoracoscopic surgery (VATS)
- immunohistochemistry
- chest MRI
- fluorodeoxyglucose (FDG) PET/CT scan
- cervical mediastinoscopy
- pulmonary function tests
- CBC
- basic metabolic panel
Emerging tests
- diagnostic biomarkers
Treatment algorithm
resectable disease
unresectable or recurrent disease
Contributors
Authors
Idrees Mian, MD
Hematologist Oncologist
Kaiser Permanente
Oncology
Washington
DC
Disclosures
IM declares he has no competing interests.
Acknowledgements
Dr Idrees Mian would like to gratefully acknowledge Dr Jaydira del Rivero, Dr Anish Thomas, Mrs Mary Hesdorffer, Dr Robert Taub, and Dr Chris R. Kelsey, the previous contributors to this topic.
Disclosures
AT, JdR, MH, RT, and CRK declare that they have no competing interests.
Peer reviewers
Marc de Perrot, MD, MSc
Associate Professor of Surgery
University of Toronto
Division of Thoracic Surgery
Toronto General Hospital
Ontario
Canada
Disclosures
MdP is an author of a reference cited in this topic.
Nicholas J. Vogelzang, MD
Chair and Medical Director
Developmental Therapeutics
Co-Chair
GU Committee
US Oncology Research
Comprehensive Cancer Centers of Nevada
Las Vegas
NV
Disclosures
NJV is a past chair of a US-based mesothelioma foundation. NJV is an author of a reference cited in this topic.
Tom Treasure, MD, MS FRCS, FRCP
Professor of Cardiothoracic Surgery (Honorary)
Clinical Operational Research Unit
Department of Mathematics
University College London
London
UK
Disclosures
TT is an author of a reference cited in this topic.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: mesothelioma: pleural [internet publication].Full text
Woolhouse I, Bishop L, Darlison L, et al. British Thoracic Society guideline for the investigation and management of malignant pleural mesothelioma. Thorax. 2018 Mar;73(suppl 1):i1-30.Full text Abstract
Popat S, Baas P, Faivre-Finn C, et al. Malignant pleural mesothelioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2022 Feb;33(2):129-42.Full text Abstract
Kindler HL, Ismaila N, Armato SG 3rd, et al. Treatment of malignant pleural mesothelioma: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018 May 1;36(13):1343-73.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Benign reactive mesothelial hyperplasia
- Benign asbestos-related pleural reactions
- Non-small cell lung cancer
More DifferentialsGuidelines
- Mesothelioma: pleural
- ACR appropriateness criteria: chronic dyspnea-noncardiovascular origin
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Pleural aspiration animated demonstration
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