The radiological manifestations of malignant pleural mesothelioma

Our plain-English summary of The radiological manifestations of malignant pleural mesothelioma, by R.M. Heller, M.L. Janower, A.L. Weber (The American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine, 1970).

The study

• Authors: R.M. Heller, M.L. Janower, A.L. Weber
• Journal: The American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine
• Published: 1970;108(1):53-9
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004312).

Abstract

Pleural mesothelioma is a frequent enough tumor to be considered in the differential diagnosis of chest tumors. The most characteristic symptoms are pain and dyspnea. A history of asbestos exposure or pulmonary asbestosis should alert the radiologist to the possibility of an existing or developing pleural mesothelioma. The important radiologic manifestations are: (1) pleural effusion, often recurrent; (2) irregular, nodular pleural thickening, with or without bone destruction; and (3) a nodular density, frequently in the peripheral portion of the lung. The prognosis is poor. Of the 10 patients studied, 7 died; 2 are alive but have persistent disease; and 1 patient, with a small nodular lesion, is cured 44 months following surgery.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This article was a case series. The authors reviewed the hospital charts and chest X-rays of 10 patients with malignant pleural mesothelioma seen at Massachusetts General Hospital in Boston from 1960 to 1967. There were 8 men and 2 women, aged 34 to 74. Six had a history of asbestos exposure; the article does not name a fiber type. Two of these six had definite pulmonary asbestosis, including a woman exposed by washing her pipefitter husband's dusty work clothes. Shortness of breath was the most common symptom, reported by 6 patients. The first chest X-rays showed three patterns: fluid around the lung (pleural effusion) in 4 patients, irregularly thickened pleura in 4, and masses that looked like lung rather than pleural tumors in 2. Diagnosis was often difficult, and in 2 patients it was made only at autopsy. Seven patients died, 5 of them within 3 months of diagnosis. Of the 3 still living, 2 had persistent disease. The authors concluded that a history of asbestos exposure or pulmonary asbestosis should alert the radiologist to possible pleural mesothelioma, and that the prognosis is poor.

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 series: review of hospital charts and chest X-rays
• Who was studied: 10 patients with malignant pleural mesothelioma (8 male, 2 female, aged 34 to 74, average 58) seen at Massachusetts General Hospital, Boston, 1960 to 1967
• Exposure: History of asbestos exposure in 6 of the 10 patients; fiber type not stated. Two of the six had definite pulmonary asbestosis, one of them a woman exposed through washing her pipefitter husband's dusty work clothes.
• Main results:
  • Shortness of breath (dyspnea) was the most common symptom, reported by 6 of the 10 patients
  • Smoking among the 10 patients: 5 were heavy cigarette smokers, 3 did not smoke, and smoking history was unavailable for 2
  • On the first chest X-rays, 4 patients showed pleural effusion
  • On the first chest X-rays, 4 patients showed irregularly thickened pleura and 2 showed masses that appeared to be in the lung rather than the pleura
  • In the 2 patients whose masses looked like lung tumors, laminagraphy and fluoroscopy did not show that the masses arose from the pleura
  • How the diagnosis was established in the 10 patients (summary table): thoracotomy 5, needle biopsy 2, autopsy 2, liver biopsy 1
  • Seven of the 10 patients died, 5 within 3 months of diagnosis. Average time from first symptoms to death was 14 months.
  • Of the 3 living patients, 2 had known persistent disease
  • One patient, who had a small nodular lesion, was described as cured 44 months after surgery
• The authors' conclusion: The authors concluded that a history of asbestos exposure or pulmonary asbestosis should alert the radiologist to possible existing or developing pleural mesothelioma. They identified pleural effusion, irregular nodular pleural thickening, and a nodular density in the lung as the main X-ray signs, and described the prognosis as poor.

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, Differential Diagnosis, Dyspnea, Asbestos Exposure, Asbestosis, Pleural Effusion, Pleural Thickening, Prognosis.

Related studies

• The radiological investigation of the early manifestations of exposure to asbestos dust — F.A. Mackenzie (1971)
• Recurrent malignant peritoneal mesothelioma: radiological manifestations — F.F. Souza, J. Jagganathan, et al. (2010)
• Radiological manifestations of malignant pleural mesothelioma — V.W. Au, M. Thomas (2003)
• Radiological survey of past and present vermiculite miners exposed to tremolite — J.C. McDonald, P. Sebastien, et al. (1986)
• Radiological features of diffuse mesothelioma — A. Solomon (1970)
• Bilateral pleural thickening: a manifestation of asbestos dust exposure — E.N. Sargent, J. Gordonson, et al. (1978)

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