A 56-Year-Old Male Ceramic Artist Presents To The Emergency Department With Diffuse Chest Pain, Malaise, Weight Loss, And Cough For 2 Months. In The Last Several Days, He Has Also Been Short Of Breath, Which Prompted His Presentation To The Emergency Department. What Test Would Be Appropriate?
CT-Scan of the Chest
The patient's presentation is classical for malignant mesothelioma. Malignant mesothelioma is associated with asbestos exposure - occupations with known asbestos exposure include ceramics, as well as shipbuilding, construction, paper mill, auto parts, railroad, and insulation.
A CT-Scan will most likely show pleural effusion and ideally pleural thickening and nodularity. Chest X-ray would also be a common choice, which would show pleural effusion, but would most likely only show advanced disease with a peripheral mass. Pleural fluid analysis could show malignant mesothelioma cells, but is usually non-diagnostic. Technically the CT-Scan is also non-diagnostic, but is the best choice given the patient's presentation and the emergency department setting. With the patient's presentation and suggestive CT-Scan, thoracoscopically guided biopsy of the pleura is 98% diagnostic for malignant mesothelioma.
