Journal of Manipulative and Physiological Therapeutics Volume 28, Issue 9 , November-December 2005, Pages 724-729. Received 22 July 2004; revised 23 June 2005. Available online 2 December 2005. [Link]
Sanjay N. Patel DCa and Norman W. Kettner DCb
aDepartment of Radiology, Logan College of Chiropractic, Chesterfield, Mo
bDepartment of Radiology, Logan College of Chiropractic, Chesterfield, MO
Objective: The aim of this study was to discuss a case of malignant pleural mesothelioma (MPM) that presented to a chiropractic teaching clinic and review the pathophysiology of diseases associated with asbestos exposure.
Clinical Features: An 86-year-old woman had right-sided back pain at the thoracolumbar junction for 3 months; this pain prevented her from exercising on a daily basis. She was alert and oriented but in obvious distress because of her back pain. Breath sounds were decreased on the right in the posterior and lower lobes, with dull percussion and increased tactile fremitus. A significant collection of pleural effusion was seen on the right side on plain film radiographs. A chest computed tomography with contrast showed a large right-sided pleural effusion with small consolidation at the right lung base suggestive of pleural or pulmonary malignancy and highly suspicious for MPM. Further questioning about asbestos exposure revealed that her husband was a maintenance worker. An extrapleural pneumonectomy was performed, and specimens of parietal and visceral pleura were sent for pathological, which revealed a definitive diagnosis of spindle cell mesothelioma.
Intervention and Outcome: The patient was diagnosed with MPM, and a surgical therapy option was considered because of the aggressive nature of the lesion and her advanced age. An extrapleural pneumonectomy was performed with removal of parietal and visceral pleura, right lower lobe, and right hemidiaphragm.
Conclusion: This is an unusual case of advanced MPM that is most likely from indirect asbestos exposure.
Key Indexing Terms: Asbestos; Asbestosis; Mesothelioma; Pleural neoplasms; Chiropractic