IPLab:Lab 12:Thoracic Mesothelioma

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Clinical Summary[edit]

This 61-year-old white male had a known history of asbestos exposure as well as a 40 pack-year history of smoking and coronary artery disease. Two years ago an open lung biopsy showed a thoracic mesothelioma. At this admission the patient complained of shortness of breath, orthopnea, and pedal edema. Physical examination revealed mild respiratory distress on nasal oxygen and a dull left hemothorax. Chest x-ray demonstrated a left hemothorax opacity, small right pleural effusions, and pleural plaques. The patient subsequently developed atrial fibrillation and immediately prior to his death he suffered a stroke.

At autopsy tumor plaque covered 100% of the left lung, 50% of the right lung, and extended into the thoracic wall, the diaphragm, and the heart.

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A pack-year denotes smoking one pack of cigarettes per day for one year.

Shortness of breath is a common clinical manifestation of heart failure.

Pleural effusion is the presence of fluid in the pleural space. Increased hydrostatic pressure in the pulmonary vasculature, as seen in heart failure, is one cause of pleural effusion.

Anthracotic pigment is coal dust deposited in the lungs--it is seen in coal miners, city-dwellers, and smokers.

A normal PaCO2 is 35 to 45 mmHg.