How Are Asbestos-Related Lung Diseases Diagnosed?

Your doctor will diagnose an asbestos-related lung disease based on your past exposure to asbestos, your symptoms, a physical exam, and the results from tests.

Specialists Involved

Your primary care doctor, such as a family doctor or internist, may think you’re at risk for or have an asbestos-related lung disease and provide ongoing care. Other specialists also may be involved in your care, including a:

• Pulmonologist. This is a doctor who specializes in diagnosing and treating lung diseases.
• Radiologist. This is a doctor who is specially trained to supervise x-ray tests and look at x-ray pictures.
• Surgeon or medical oncologist. A medical oncologist is a doctor who specializes in diagnosing and treating cancer. The surgeon or oncologist may take a tissue sample from you to study under a microscope.
• Pathologist. A pathologist is a doctor who specializes in identifying diseases by studying cells and tissues under a microscope. A pathologist may study your tissue sample.

Exposure to Asbestos

Your doctor will want to know about your history of asbestos exposure. He or she may ask about your work history and your spouse's or other family members’ work histories.

Your doctor also may ask about your location and surroundings. For example, he or she may ask about areas of the country where you've lived.

If you know you were exposed to asbestos, your doctor may ask questions to find out:

• How much asbestos you were exposed to. For example, were you surrounded by visible asbestos dust?
• How long you were exposed to asbestos and how often during that time you were in direct contact with it.

Symptoms

Your doctor may ask whether you have any symptoms, such as shortness of breath or cough. The symptoms of asbestos-related lung diseases vary, depending on the disease and how much lung damage has occurred.

Your doctor also may ask whether you smoke. Smoking, along with asbestos exposure, raises your risk for lung cancer.

Physical Exam

Your doctor will listen to your breathing with a stethoscope to find out whether your lungs are making any strange sounds.

If you have a pleural effusion with a lot of fluid buildup, your doctor might hear a dull sound when he or she taps on your chest. Or, he or she might have trouble hearing any breathing sounds. If you have asbestosis, your doctor may hear a crackling sound when you breathe in.

Your doctor will check your legs for swelling, which may be a sign of lung-related problems. He or she also will check your fingers for clubbing. Clubbing is the widening and rounding of the tips of your fingers and toes.

Clubbing most often is linked to heart and lung diseases that cause lower-than-normal blood oxygen levels.

Chest X Ray

Chest x ray is the most common test for detecting asbestos-related lung diseases. A chest x ray is a painless test that creates pictures of the structures inside your chest, including the lungs.

A chest x ray can’t detect asbestos fibers in the lungs. However, it can show asbestos-related diseases, such as pleural plaque and pleural effusion. Pleural effusion also can be a sign of more severe disease, such as mesothelioma.

A chest x ray also can show asbestosis. Often the lung tissue will appear very white. The size, shape, location, and degree of whiteness can help your doctor figure out how much lung damage you have. Severe asbestosis may affect the whole lung and have a honeycomb look on the x-ray pictures.

If you have lung cancer, a chest x ray may show masses or abnormal fluid.

If you have mesothelioma, a chest x ray will show thickening of the pleura. The pleura is the tissue around the lungs and diaphragm (the muscle below your lungs). The chest x ray also will usually show signs of pleural effusion in people who have mesothelioma.

Other Diagnostic Tests

To help confirm a chest x-ray finding or to find out how much lung damage you have, you may have more tests.

Chest Computed Tomography Scan

A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, is a painless test that creates precise images of the structures inside your chest, such as your lungs. A CT scan is a type of x ray, but its pictures show more detail than standard chest x ray pictures.

For asbestos-related lung diseases, a chest CT scan can give doctors more precise information about the condition of your lungs. This may be very helpful for finding asbestosis in its earliest stages, before a standard chest x ray can detect it.

Lung Function Tests

Lung function tests measure the size of your lungs, how much air you can breathe in and out, how fast you can breathe air out, how well your lungs deliver oxygen to your blood, and how much oxygen is in your blood.

These tests can show whether your lung function is impaired. They also can help your doctor track your disease over time.

Biopsy

The only way to confirm a diagnosis of lung cancer or mesothelioma is for a pathologist to check samples of your cells or tissues. A pathologist is a doctor who identifies diseases by studying cells and tissues under a microscope.

There are many ways to collect tissue samples. One way is through bronchoscopy (bron-KOS-ko-pee). For this procedure, your doctor will pass a thin, flexible tube through your nose (or sometimes your mouth), down your throat, and into the airways. He or she will then take a sample of tissue from your lungs.

If mesothelioma is suspected, you may have a thoracoscopy (thor-a-KOS-ko-pee). For this procedure, you'll have anesthesia so you don't feel any pain. Your doctor will make a small cut through your chest wall.

He or she will put a thin tube with a light on it into your chest between two ribs. This allows your doctor to see inside your chest and get tissue samples.