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Diagnosis of mesothelioma can be suspected with imaging but is confirmed with biopsy. It must be clinically and histologically differentiated from other pleural and pulmonary malignancies, including reactive pleural disease, primary lung carcinoma, pleural metastases of other cancers, and other primary pleural cancers. [12]
Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis (pulmonary fibrosis due to asbestos), diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.
Asbestos warning label. Figure A shows the location of the lungs, airways, pleura, and diaphragm in the body. Figure B shows lungs with asbestos-related diseases, including pleural plaque, lung cancer, asbestosis, plaque on the diaphragm, and mesothelioma. Left-sided mesothelioma (seen on the right of the picture): chest CT
A plaque caused by asbestos exposure on the diaphragmatic pleura: Specialty: Pulmonology: Symptoms: Shortness of breath, cough, wheezing, chest pain [1] Complications: Lung cancer, mesothelioma, pleural fibrosis, pulmonary heart disease [1] [2] Usual onset ~10-40 years after long-term exposure [3] Causes: Asbestos [4] Diagnostic method
Pleural plaques are patchy collections of hyalinized collagen in the parietal pleura. [2] They have a holly leaf appearance on X-ray. [1] They are indicators of asbestos exposure, and the most common asbestos-induced lesion. [3] They usually appear after 20 years or more of exposure and never degenerate into mesothelioma.
The location of the lesions is mostly in the upper lobes of the lungs, usually in a lymphatic distribution. Thickening of the pleura and interlobular septal is also evident. In addition, pleural/pericardial effusions and mediastinal fat infiltration is appreciated. Definitive diagnosis is achieved through tissue biopsy. [1]
Pleural tumors may be benign (i.e. solitary fibrous tumor) or malignant in nature. Pleural mesothelioma is a type of malignant cancer associated with asbestos exposure. Under most other circumstances, pleural cancers are secondary malignancies associated with lung cancer due to its nearby location or as metastasis such as with breast cancer.
Pneumoconiosis is the general term for a class of interstitial lung disease where inhalation of dust (for example, ash dust, lead particles, pollen grains etc) has caused interstitial fibrosis. [ 1 ] [ 2 ] The three most common types are asbestosis , silicosis , and coal miner's lung . [ 3 ]
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