Makindo Medical Notes"One small step for man, one large step for Makindo" |
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π« Mesothelioma encasing the lung β classically a malignant pleural tumour strongly linked to asbestos exposure.
Case 1 β Occupational Exposure π·ββοΈ A 68-year-old retired shipyard worker presents with progressive shortness of breath, dull right-sided chest pain, and weight loss. Exam: reduced breath sounds and stony dullness to percussion over the right lower chest. Chest X-ray: large unilateral pleural effusion. Pleural aspiration: exudative, cytology inconclusive. π Diagnosis: Likely malignant mesothelioma (confirmed on VATS biopsy). π Key points: Strong asbestos exposure history, unilateral effusion, poor prognosis. π Management: Palliative β pleurodesis for effusion control, chemotherapy (pemetrexed + cisplatin), symptom management.
Case 2 β Chest Wall Invasion π« A 72-year-old man with past asbestos insulation work presents with severe chest wall pain, breathlessness, and fatigue. Exam: palpable hard mass over the left lateral chest wall, reduced chest expansion, clubbing. CT thorax: irregular pleural thickening encasing the lung, with invasion into chest wall muscles. Histology from pleural biopsy: epithelioid mesothelioma. π Key points: Advanced disease with local invasion, chest pain dominant symptom. π Management: Palliative care β analgesia (including nerve blocks), radiotherapy for pain, chemotherapy considered if fit.