CLINICAL CASE of Parietal Mesothelioma
A 77 year old man with a background history of Alzheimer's disease, ischaemic heart disease, carotid artery stenosis and gastric ulcers, presented with a one week history of breathlessness. There was no associated cough, haemoptysis, weight loss, anorexia or other symptoms . He was apyrexial and inflammatory markers were slightly elevated. A chest X-ray suggested right basal consolidation with an associated small effusion.Further to vague abdominal discomfort and a palpable fullness in the right upper quadrant, an USS was performed. This showed a large (13 cm) subhepatic heterogenous soft tissue mass. In addition, the mass was felt to be infiltrating the anterior abdominal wall and was closely related to the hepatic flexure. There were upper lobe emphysematous changes in the chest with bilateral pleural thickening and calcifications, in addition to an increasing right pleural effusion. A previous abdominal ultrasound 4 years ago was normal.An ultrasound-guided biopsy of the abdominal mass was performed, and histology identified a spindle cell tumour.his occupational history revealed that he had worked as an assistant plumber for at least 2 years, approximately 50 years ago. He acknowledged working closing with pipes, and possible exposure to asbestos. and thus diagnosed.