Mesothelioma is an aggressive cancerous tumor of the pleura or covering of the lung. The tumor is associated with exposure to asbestos fibers. The disease often occurs decades after the exposure. Patients typically present with hard time breathing, chest pain and pain in the back. Given how many other diseases can have these symptoms, a chest X-ray is often the starting point for symptoms that are thought to originate from the chest.
The diagnosis of mesothelioma will not be made from an X-ray alone. The appearance can overlap with many other conditions. The diagnosis can be suggested when we see opacities or masses around the pleura, rib destruction, pleural effusion or fluid around the lung, and big lymph nodes. These finding will often prompt further testing with a chest CT.
Other possibilities for these findings when seen on chest X-ray can be from cancer spreading to the pleura. Benign tumors of the pleura. Benign conditions such as scarring or inflammation from prior infections. Pleural effusion has a broad differential as well.
Tissue sample will be needed to make a definitive diagnosis, although the tumor can spread along the biopsy track. The prognosis for mesothelioma is poor with median survival of 1-2 years. The tumor is locally aggressive and can invade the chest wall and muscle. The tumor can spread to lymph nodes and the opposite lung as well.
A PET scan can be done to evaluate the entire extent of tumor as well as any distant spread to places like the liver. Few patients will benefit from current treatment. Treatment can include a lung resection, chemotherapy and radiation therapy.