Asbestosis & Mesotheliomas

Question 1

Define asbestosis:

Answer 1

long term inflammation and scarring of the lung due to inhalation of asbestos fibres

Question 2

Define mesothelioma:

Answer 2

aggressive tumour of the mesothelium (epithelial layer that lines many cavities) mainly affecting the pleura (90%), pericardium, testes and peritoneum.

Question 3

Aetiology of asbestosis:

Answer 3

Asbestos was used in the building trade

Degree of exposure correlates to the amount of pulmonary fibrosis

inflammation can lead to mesothelial plaques

Question 4

aetiology of mesothelioma:

Answer 4

90% are associated with exposure to asbestos but only 20% have pulmonary asbestosis.

Can be latent for 45 years before malignancy develops

rarely spreads to a distant site but has a poor prognosis as usually advanced on point of diagnosis

Question 5

Epidemiology:

Answer 5

mesothelioma is rare but more common in the elderly

90% associated with asbestos but there can be latent period of 50 years

Question 6

Symptoms of asbestosis

Answer 6

progressive dyspnoea

Question 7

symptoms of mesothelioma:

Answer 7

SOB
Chest pain (diffuse, dull and developing)
weight loss
night sweats
fever
bone pain
abdo pain
bloody sputum if tumour invades blood vessels
fatigue

Question 8

signs of asbestosis:

Answer 8

Clubbing due to the pulmonary fibrosis

Fine crackles at the end of inspiratory phase

Question 9

signs of mesothelioma:

Answer 9

clubbing - pulmonary fibrosis

may have palpable chest mass

recurrent pleural effusions

signs of metastes - hepatomegaly, lymphadenopathy, bone tenderness

abdo pain

pneumothroax (very rare)

Question 10

investigations for asbestosis:

Answer 10

History and exam

CXR- reticular nodular shadowing +/- pleural plaques

Question 11

investigations for mesothelioma:

Answer 11

CXR/CT - pleural thickening or effusions

MRI/PET

Pleural fluid analysis

Pleural biopsy - immunostaining reacts with the CALRETININ to give fried egg appearance