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 when in his twenties he had worked on a construction crew installing insulation in public buildings. The patient had a 40 pack-year history of smoking and a history of coronary artery disease requiring a coronary artery bypass graft ten years prior to his final admission. Two years prior to this admission, an open lung biopsy showed the patient to have a thoracic mesothelioma for which he was treated with radiation therapy. The patient was then placed on steroidal and nonsteroidal pain medications and a nerve block was performed to help alleviate the discomfort. On final admission, the patient complained of shortness of breath, orthopnea, and pedal edema. Physical examination revealed mild respiratory distress on nasal oxygen, a dull left hemothorax, and right basal bronchial breath sounds with scattered rales. 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.

Autopsy Findings[edit]

Tumor plaque covered 100% of the left lung, 50% of the right lung, and extended into the thoracic wall, the diaphragm, and the heart. No evidence of tumor metastases was found outside the thoracic cavity. The brain showed acute hypoxic injury of the hippocampus although no thrombus was found.


Virtual Microscopy[edit]

Study Questions[edit]

Additional Resources[edit]


Journal Articles[edit]


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.

A thrombus is a solid mass resulting from the aggregation of blood constituents within the vascular system.

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.