| OBJECTIVE: To discuss the case of a patient with malignant mesothelioma presenting in a chiropractic office with musculoskeletal symptomatology. CLINICAL FEATURES: A 46 year old male, with a three-month history of progressively worsening left sided lower neck pain with extension into the shoulder, sought treatment at a chiropractic clinic. Plain film cervical spine radiography revealed opacification of the left lung apex. This was followed by chest radiography which demonstrated extensive, lumpy, soft tissue thickening along the left lateral chest wall extending into the apex, with hazy opacification of the left lung and slight upper mediastinal deviation to the right. INTERVENTION AND OUTCOME: Patient was referred to a primary care medical physician for subsequent management including pulmonary consultation, chest CT and biopsy. DISCUSSION: Malignant mesothelioma is a rare primary pleural malignancy with approximately 3000 cases reported annually in the United States and has a strong association to asbestos exposure. This case illustrates the importance of including careful evaluation of the lung apices on cervical spine radiographs. Although primary pulmonary neoplasm would always be a first consideration for apical opacification in this age group, this case illustrates the importance of careful correlation of patient symptomatology, radiographic findings and past patient history. This abstract is reproduced with the permission of the publisher. |
