Malignant Mesothelioma

Delayed

Step 1: View clinicals

An 85 year old man presents with progressive dyspnea, fatigue and anorexia for three months. He also experienced pain in the lower right side of his chest during this time. He was a shipyard worker for 30 years, retiring at the age of 55. His medical history is unremarkable. There is no family history of lung disease.


Step 2: Order all relevant investigations

X-ray Chest

There is a moderate pleural effusion in the right hemi-thorax.

Pleurocentesis

Protein: 3.5 g/dL Pleu. fluid:Serum protein: 0.67 LDH: 240 IU/L Pleu. fluid:Serum LDH: 0.7 AFB: -ve IFN-gamma release test: -ve Gram stain & culture: -ve Cytology: +ve for malignant cells

CT Chest (Contrast)

A moderate right sided pleural effusion is noted. A nodular mass contiguous with the right parietal pleura is seen. There is no mediastinal lymphadenopathy.

CT guided biopsy

Histology of the biopsy sample is suggestive of a malignant mesothelioma of the epithelioid type. There is no evidence of vascular or lymphatic invasion, and regional lymph nodes are negative for disease.


Step 3: Select appropriate management

R/s Pneumonectomy
Antituberculous therapy
Chemical pleurodesis
Radiotherapy


Score: ★★☆