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Physical signs of mesothelioma

The physical signs of malignant pleural mesothelioma are usually those of a pleural effusion or pleural mass (reduced chest expansion, stony dullness to percussion, reduced intensity or absence of breath sounds, etc.). Large effusions or tumour masses can cause mediastinal displacement. The tumour may erode through the chest wall and cause localised tenderness and/or palpable masses. When the tumour has spread within the pleural cavity it is common to see a ‘fixed’ hemithorax, with reduced chest expansion.

Mesothelioma masses alone cause dullness to percussion and reduced breath sounds, but occasionally breath sounds are harsh, almost bronchial in the absence of effusions. Signs of compression or invasion of mediastinal structures, particularly the superior vena cava or the phrenic or cervical nerves, may be present. Signs of extrathoracic involvement are uncommon on presentation, occurring in only 11% of patients in one large series.

mesothelioma lumps in the axillae of two patients. In both cases the tumour spread through the chest wall via a previous thoracentesis site.


Clubbing of the fingers is not a feature of malignant mesothelioma and when present may indicate coexisting pulmonary fibrosis from asbestosis.
Signs of ascites, abdominal tenderness or palpable abdominal masses are common with peritoneal mesothelioma.

Radiological appearance of a patient presenting with mesothelioma. Shown are the chest x-ray (left) and thoracic CT scan (right), clearly demonstrating a large mass in the right upper zone with some pleural fluid on that side.

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