Diagnostic delay in malignant pleural mesothelioma due to physicians fixation on history with non-exposure to asbestos

Our plain-English summary of Diagnostic delay in malignant pleural mesothelioma due to physicians fixation on history with non-exposure to asbestos, by P.H. Madsen, C.B. Laursen, J.R. Davidsen (BMJ Case Reports, 2013).

The study

• Authors: P.H. Madsen, C.B. Laursen, J.R. Davidsen
• Journal: BMJ Case Reports
• Published: 2013;2013
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

To establish the diagnosis of virtually any disease, the clinician must combine a variety of information. Often emphasised in this context is thorough medical history-taking including information on exposure to factors leading to or being associated with the disease in question. Continuous assessment of all available information is of utmost importance, as fixation on single details can be misguiding with inappropriate consequences in both the diagnostic and therapeutic approach. This case report presents how an atypical medical history led to a delay in the diagnosis of malignant pleural mesothelioma due to a low a priori likelihood of the disease because of non-exposure to asbestos. We highlight the fact that postrationalisation and attempts to renew a diagnostic approach must be carried out each time diagnostic dilemmas emerge, and when some or all diagnostic clues disagree.

In plain English

This article was a case report about a middle-aged woman with no previous medical history who was admitted to hospital with fever and other symptoms. On detailed questioning, neither she nor her relatives reported any history of exposure to asbestos. Chest imaging showed thickening of the lining of the left lung and some fluid at its base. Because of her fever, a raised blood marker of inflammation (C reactive protein) and the lack of asbestos exposure, doctors first considered empyema, an infection in the chest lining, the most likely diagnosis. They treated it with intravenous antibiotics and a chest tube. When that treatment failed, they performed keyhole chest surgery about 1 month after her first hospital contact. Biopsies taken during the surgery showed biphasic malignant mesothelioma of the pleura (the lining around the lungs). She was then treated with carboplatin and pemetrexed but died 5 months after her first admission. No autopsy was performed. The authors concluded that malignant pleural mesothelioma should be considered even when no exposure to asbestos can be established.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: one middle-aged woman with no previous medical history, admitted to hospital
• Exposure: No asbestos exposure was found: on detailed questioning, the patient and her relatives reported no history of asbestos exposure.
• Main results:
  • Chest x-ray and CT showed left-sided pleural thickening and basal pleural effusion.
  • Because of fever, elevated C reactive protein and the lack of asbestos exposure, empyema was initially considered the most likely diagnosis.
  • Treatment for empyema with antibiotics and pleural drainage failed, which led doctors to consider malignant pleural mesothelioma.
  • Video-assisted thoracoscopic surgery, done about 1 month after first hospital contact, produced biopsies showing biphasic malignant mesothelioma.
  • The patient was treated with carboplatin and pemetrexed after diagnosis.
  • Despite treatment, the patient died 5 months after her initial hospital admission. No autopsy was performed.
• The authors' conclusion: The authors concluded that, when planning diagnostic work-up for pleural disease, malignant pleural mesothelioma should be considered even when no exposure to asbestos can be established.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

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