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 test results.

Specialists Involved

Your primary care doctor, such as a family doctor or internist, may provide ongoing care if you have an asbestos-related lung disease. 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 oncologist. An oncologist is a doctor who specializes in diagnosing and treating cancer. The surgeon or oncologist may take a tissue sample from your lungs 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 coughing. The symptoms of asbestos-related lung diseases vary. They depend on which disease you have and how much it has damaged your lungs.

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 and toes for clubbing.

Clubbing is the widening and rounding of the fingertips and toes. Clubbing most often is linked to heart and lung diseases that cause lower-than-normal blood oxygen levels.

Chest X Ray

A chest x ray is the most common test for detecting asbestos-related lung diseases. This painless test creates pictures of the structures inside your chest, such as 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 a more severe disease, such as mesothelioma.

A chest x ray also can show asbestosis. Often the lung tissue will appear very white on the x-ray pictures. 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 pictures 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.

A chest CT scan 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 how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to 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 lung cells or tissues. A pathologist is a doctor who identifies diseases by studying cells and tissues under a microscope.

Doctors have 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 your airways. He or she will then take a sample of tissue from your lungs.

If your doctor thinks you have mesothelioma, you may have a thoracoscopy (thor-ah-KOS-ko-pee). For this procedure, you'll be given medicine 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.

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