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 scan of the chest and upper abdomen with intravenous contrast
Tests to consider
- thoracentesis
- pleural biopsy
- video-assisted thoracoscopic surgery (VATS)
- immunohistochemistry
- chest MRI
- PET scan
- cervical mediastinoscopy
- pulmonary function tests
- CBC
- basic metabolic panel
Emerging tests
- biomarkers
Treatment algorithm
operable disease
inoperable 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.
Differentials
- Benign reactive mesothelial hyperplasia
- Benign asbestos-related pleural reactions
- Non-small cell lung cancer
More DifferentialsGuidelines
- Clinical practice guidelines in oncology: mesothelioma: pleural
- Suspected cancer: recognition and referral
More GuidelinesVideos
Pleural aspiration animated demonstration
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