History and Physical Examination
Despite the banning or reduction of asbestos since the 1960s, the incidence of mesothelioma continues to increase because patients develop mesothelioma 20-40 years after asbestos exposure. The long latency period adds to the complexities of early diagnosis and treatment of the condition.
The patient’s occupational history is important, and family members with exposure to asbestos should also be evaluated.
Dyspnea and nonpleuritic chest wall pain are the most common presenting symptoms of malignant mesothelioma, with at least 1 of these occurring in 60-90% of patients. Chest discomfort, pleuritic pain, easy fatigability, fever, sweats, and weight loss are the other common accompanying symptoms.
Patients may also be asymptomatic, with evidence of a pleural effusion noted incidentally on physical examination or by chest radiograph.
Metastatic disease is uncommon at presentation; contralateral pleural abnormalities are usually secondary to asbestos-related pleural disease rather than to metastatic disease.
In patients with malignant mesothelioma, physical findings of pleural effusion are usually noted upon percussion and auscultation.
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