ACCP “Case Puzzler” Offers Physicians an Opportunity to Follow Mesothelioma Diagnosis
The American College of Chest Physicians’ website current Case Puzzler presents the case of a 70-year old woman with no history of occupational exposure to vapors, gases, dusts, fibers, or fumes, who is diagnosed with malignant epitheloid mesothelioma. Her physicians determined that she was a victim of “bystander asbestos exposure” from asbestos dust brought home on her father’s clothes throughout her childhood.
Mesothelioma is a rare, aggressive cancer that is primarily caused by exposure to airborne asbestos fibers. Symptoms of mesothelioma may not appear until up to 50 years after initial exposure to the asbestos. A wide array of workers were exposed to asbestos including shipyard workers, factory workers, pipefitters, sheet metal workers, plumbers, laborers, machinists, mechanics, powerhouse workers, and electricians.
Asbestos is so toxic that mesothelioma has been diagnosed in family members whose only exposure came from contact with the fibers that adhered to the clothes of the worker/tradesperson who actually worked with asbestos products. The woman’s father died of cancer of unknown primary site. The type of work in which he was engaged was not revealed.
The case study leads the reader through the steps of diagnosis including showing the results of the initial abdominal and chest CT scans indicating a left-sided pleural effusion. The next test, thoracentesis, was performed showing atypical cells suggestive of, but not diagnostic of, a malignancy.
The “answer” shows the complete diagnosis as well as a discussion including the patient’s medical history and information on mesothelioma diagnosis and treatment.
Case Puzzlers are brief clinical vignettes on various educational topics. Developed by members of the American College of Chest Physicians’ NetWorks, it provides members with an opportunity to sharpen their skills.