History, exam, tests, drugs and interventions. Licence: Adapted by Geeky Medics. Instagram: https://instagram.com/geekymedics McGee,7 on the other hand, calculated the positive likelihood ratio of asymmetric chest expansion at 44.1. Introduce yourself to the patient including your name and role. Clinical = decreased chest wall movement on the affected side, dull percussion note on affected side, decreased air entry on affected side and decreased vocal resonance. Crackles have long been taught as a common physical finding in pneumonia. 3. Licence: Adapted by Geeky Medics. Assess the patients respiratory rate for 60 seconds to calculate the number of breaths per minute. Despite being rare, mesotheliomais an aggressive type of cancer that develops in the mesothelial cells. Restrictive lung disease, a decrease in the total volume of air that the lungs are able to hold, is often due to a decrease in the elasticity of the lungs themselves or caused by a problem related to the expansion of the chest wall during inhalation. Compare this space to the other side of the trachea using the same process. control group. Learn more about the causes, symptoms, and treatment options, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Stand behind patient. 1 Hypovolemia 2 Cystic fibrosis 3 Angina pectoris 4 The asbestos fibers become trapped in these cells, which surround some organs, forming a membrane known as the mesothelium. From Diaz-Guzman E, Budev MM. flow (PEF), and predicted pulmonary function (pred FVC, pred FEV1, pred First, evaluate the patient for asymmetric chest expansion. See our cardiovascular examination guide for details on how to elicit hepatojugular reflux. This respiratory examination OSCE guide provides a clear step-by-step approach to examining the respiratory system, with an included video demonstration. Ask the patient to say 99 repeatedly at the same volume and in the same tone. Therefore, in severe cases, the fluid prevents the lungs from normally functioning, causing difficulties breathing, wheezing, shortness of breath and reduced chest expansion. Absent cardiac dullness had a positive likelihood ratio of 16 and a negative likelihood ratio of 0.8 for diagnosing COPD in a study in 92 patients with a history of smoking or self-reported COPD.21 The kappa score was 0.49, signifying moderate interobserver agreement. Check out our other awesome clinical skills resources including: Given both tests assess the same thing, there is no reason to perform both vocal resonance and tactile vocal fremitus in the same examination. thoracic region are involved in pulmonary function improvement is controversial. A reduction in the crico-sternal distance and tracheal tug signify marked chest hyperexpansion, usually COPD. Copyright 2017 The Cleveland Clinic Foundation. Place subsequent fingers, in the vertical plane, below this into the sternal notch until the trachea is no longer palpable and the sternum is reached. Any of the following may be used for treating lung disease. An increase in the jugular venous pressure of 3 cm from baseline constitutes a positive abdominojugular reflux. Heart failure with preserved ejection fraction has not been well studied for physical examination. Physical signs can be subjective and lack sensitivity and specificity. Copyright 2013-2023 All rights reserved. Causes and Risk Factors of Pneumonia Paralysis of the Diaphragm Assessing the central venous pressure by estimating the vertical height of distention of the right internal or external jugular vein is validated and easily reproducible.23,24 The use of the external jugular vein is supported by correlation with catheter-measured central venous pressure in critically ill patients.25,26 The central venous pressure reflects the right atrial pressure, and in the absence of tricuspid stenosis, the right ventricular end-diastolic pressure. function. During a thoracentesis, a local anesthesia is applied and an ultrasound or CT scan may be used to guide the needle. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. increased chest distension; decreased chest expansion; bilaterally decreased air entry; increased autoPEEP in the expiratory hold manoeuvre; increased peak airway pressures; increased plateau pressures; short expiratory time setting on the ventilator; Causes of intrinsic PEEP. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Either vocal resonance or tactile fremitus in a patient with asymmetric chest expansion would strongly support the diagnosis of pneumonia. This is an umbrella term for a large group of diseases that cause scarring of the lungs. Dullness to percussion has a low positive likelihood ratio for pneumonia but a moderate one for pleural effusion.13 The absence of this sign is only modest in excluding a pleural effusion (negative likelihood ratio 0.31 in pooled data analyzed by Wong et al).13. 6. Normally, a 2-5" of chest 8600 Rockville Pike Using a maximal-effort expiratory spirogram, forced vital capacity (FVC), forced 8 What do you need to know about chest expansion? times per week for 6 weeks5). The right side is preferred due to its anatomically direct route to the heart. Measure the JVPby assessing the vertical distance between the sternal angle and the top of the pulsation point of the IJV (in healthy individuals, this should be no greater than 3 cm). They are often progressive, meaning that they worsen over time. A spirometer (Pony Fx, COSMED, Italy) was used to measure pulmonary Other tests are necessary for a confirmed diagnosis and to ensure the most effective treatment plan. Inspect for any evidence of lymphadenopathy or irregularity of the neck. Therefore, the present study examined self-mobilization of thoracic vertebrae in healthy Pleural effusionsconsist on a large amount of fluid accumulated between the lungs and chest cavity. Stridor has a wide range of causes, including foreign body inhalation (acute) and subglottic stenosis (chronic). Accuracy of the physical examination in evaluating pleural effusion. Desherinka. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ These results may be attributable to the fact that although thoracic region Wilcoxon signed-rank test was used to compare differences between the Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. To meet the body's oxygen needs, the person's breathing rate. Respiratory examination frequently appears in OSCEs and youll be expected to pick up the relevant clinical signs using your examination skills. chest wall declines owing to over activation of the muscle spindles, potentially leading to Causes of Decreased Chest Expansion Bilateral Airway obstruction - asthma, COPD Pulmonary fibrosis Musculoskeletal - arthritides, rib fracture Unilateral Pneumothorax Atelectasis Next Page Want more info like this? had undergone operations, or were receiving surgical treatment, or taking medicines on a We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. A difference in the amount of space between the sides suggests the presence of tracheal deviation. As reported in previous studies, chest mobilization exercises and stretching exercises The physical examination, with its roots extending at least as far back as Hippocrates, may be at a crossroads as the mainstay of diagnosis. A look at interstitial lung disease, a group of diseases that make it difficult to get enough oxygen. 1. Exposure of the patients lower legs is also helpful to assess for peripheral oedema. participant felt pain or inconvenience, the self-mobilization tool was moved toward the Disorders that restrict lung expansion or weaken the muscles that aid breathing may gradually cause respiratory acidosis. We never use your cookies for creepy ad retargeting that follows you around the web. However, we firmly believe that the traditional techniques have stood the test of time and have a future in the clinical practice of medicine. Intrinsic restrictive lung diseases usually result from inflammation and scarring of lung tissue. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? That is why it is important to have patient erect and use equal amount of pressure with hands in assessing chest expansion. Ankit Jain, MBBS, corresponding author Anuradha Patel, MD, FRCA and Ian C. Hoppe, MD. This video demonstrates how to perform chest compressions in the context of cardiopulmonary resuscitation (CPR) in an OSCE setting. Palpate the apex beat with your fingers placed horizontally across the chest. disease or obstructive pulmonary disease, as determined by a spirometer pretest. very high FRC and have limited capability to expand the chest from this position. to address these issues, those interventions have shortcomings because they require Unilaterally decreased expansion is a useful finding as the pathology is invariably on the side of decreased expansion, Obstructive lung diseases, particularly COPD or asthma. Copyright 2013-2023 Oxford Medical Education Ltd. Myasthenia Gravis (MG) Neurological Examination, Questions about DVT (Deep Vein Thrombosis), Endotracheal tube (ETT) insertion (intubation), Supraglottic airway (e.g. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. There is currently no cure for mesothelioma, but there are treatment options that can help ease the symptoms. 1. Restrictive lung diseases are chronic conditions that limit the ability of the lungs to expand during inhalation. This video demonstrates how to use an automated external defibrillator (AED) in the context of cardiopulmonary resuscitation (CPR). A common mistake is a piano-playing or spiders legs technique with the fingertips over the skin rather than correctly using the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue. There was no evidence of a fine tremor or asterixis., The pulse was regular at 70 beats per minute and the respiratory rate was 16 breaths per minute., On inspection of the face, there were no stigmata of respiratory disease., Assessment of the JVP did not reveal any abnormalities. Enter a Melbet promo code and get a generous bonus, An Insight into Coupons and a Secret Bonus, Organic Hacks to Tweak Audio Recording for Videos Production, Bring Back Life to Your Graphic Images- Used Best Graphic Design Software, New Google Update and Future of Interstitial Ads. mobilized, chest region muscle stiffness persists and the mobility of the muscles around the The clinical presentation of acute congestive heart failure has much in common with pneumonia, pleural effusion, and COPD. Deep inspiration breath-hold for left-sided breast irradiation: Analysis of dose-mass histograms and the impact of lung expansion. The trachea was centrally located and the cricosternal distance was within the normal range., Closer inspection of the chest did not reveal any scars or chest wall deformities. The most common cause of nonobstructive atelectasis is anesthesia because it reduces surfactant and decreases alveolar volume. 1 Obesity 2 Anemia 3 Pregnancy 4 Neuromuscular disease 2 The nurse reviews a patient's cardiopulmonary health history and identifies that which diagnosis impacts cardiac oxygenation? associated with impaired spinal mobility: a comparative study. Conversely, the lower the negative likelihood ratio, the lower the probability that a person without the finding actually has the disease. The specific tests involved depend on whether the suspected cause is intrinsic or extrinsic. These patients have a Pleural effusion commonly occurs in patients with congestive heart failure, pneumonia, and malignancies. Any lung or pleural disease can give rise to a decrease in These rules often have higher diagnostic accuracy but drawbacks of taking more time and not being easily reproducible. Gain consent to proceed with the examination. Asymmetrical chest expansion, diminished breath sounds, egophony, bronchophony, and tactile fremitus can be used in combination to accurately diagnose pneumonia and pleural effusion. Checking for asymmetry in chest expansion, a specific but not sensitive sign of pneumonia and of pleural effusion. relatively less affected by the intervention. James Heilman, MD. If you'd like to support us, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. Example: Let us say that the patient has decreased chest expansion on right side. The scarring leads to stiffness that makes it difficult to breathe and get oxygen to the bloodstream. which can cause rapid breathing. Unilateral decreased chest expansion, which is easier to detect, indicates pathology on that side, for example pneumothorax, pleural effusion, pneumonia and collapsed lung. 3. It is typically low in patients with COPD. What does decreased chest expansion mean? This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It does not provide medical advice, diagnosis or treatment. Estimation of central venous pressure by examination of jugular veins, Validity of the hepatojugular reflux as a clinical test for congestive heart failure, Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients, Non-invasive method for the rapid assessment of central venous pressure: description and validation by a single examiner. Position the diaphragm of the stethoscope over each of the relevant locations on the chest wall to ensure all lung regions have been assessed and listen to the breathing sounds during inspiration and expiration. Advanced air-flow limitation in patients with COPD leads to reduced lung volume, respiratory muscle strength, and exercise capacity. Relax your shoulders and sit back or lie down. Symptoms of restrictive lung disease include cough, shortness of breath, wheezing and chest pain. increasing chest expansion in healthy adults. A likelihood ratio of 1 means the test or finding is no better than chance. Therefore, we are uncertain about a conclusion for this physical finding based on the concern for wide ranges in likelihood ratio and poor interobserver reliability. 14.90kg, respectively in the CG. It is typically low in patients with COPD. A systematic review found that likelihood ratios vary widely and confidence intervals are wide.36 Interobserver agreement also varies widely (kappa scores 0.17 to 0.84).7 In a primary care study,37 a third heart sound had a very low sensitivity (4.3%) but a specificity of 99.8%. However, these Federal government websites often end in .gov or .mil. Auscultation locations on the anterior chest, Palpate the submental and submandibular lymph nodes, Palpate the tonsillar and parotid lymph nodes, Palpate the superficial cervical lymph nodes, Palpate the posterior cervical lymph nodes, Percussion locations on the posterior chest wall, Auscultation locations on the posterior chest wall, Assess the legs for signs of deep vein thrombosis, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjdLRjVfQnI5TWFF, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LmNrVXZhUS16NHhB, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjNZNXNPMlJFVTJv, Start typing to see results or hit ESC to close, Cushings Syndrome Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Explaining a Gastroscopy (Endoscopy) OSCE Guide, Paediatric Basic Life Support (BLS) OSCE Guide, Paediatric Growth Assessment OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, In a healthy individual, you should be able to observe a, Ask the patient to hold out their hands in an outstretched position and observe for a fine tremor which is typically associated with, Whilst the patient still has their hands stretched outwards, ask them to. Chapters: 3. Needed is a simple, evidence-based approach to the physical examination that enhances its diagnostic accuracy while maintaining bedside efficiency. Respiratory causes of a displaced apex beat: 1. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Assessing vocal resonance involves auscultating over different areas of the chest wall whilst the patient repeats a word or number consistently. HHS Vulnerability Disclosure, Help The apex beat was palpable in the 5th intercostal space, in the mid-clavicular line and chest expansion was equal., Percussion of the chest revealed normal resonance throughout all lung fields., Auscultation of the chest revealed normal vesicular breath sounds, with no added sounds. [Subjects] Symmetric but increased expansion suggests paralysis of the diaphragm with compensatory intercostal. regular basis to relieve pain, were excluded from the study. Intrinsic restrictive lung diseases affect the functional tissue of the lung, including the alveoli, capillaries, and the interstitium. Inspect for evidence of erythema nodosum, which can be associated with sarcoidosis. Diminished breath sounds (positive likelihood ratio 2.5 based on 3 studies with 1,828 patients).1012. An abnormal finding is defined by an apical impulse displaced laterally (to the left of the midclavicular line). It has a positive likelihood ratio of 8.0 and a negative likelihood ratio of 0.3 for the diagnosis of congestive heart failure by the assessment of end-diastolic pressure of the left ventricle (Table 5).2931, The abdominojugular reflux is a much more reliable test than examination of neck veins for jugular venous pressure. Hepatojugular reflux test Clinical and echocardiographic characeristics and cardiovascular outcomes according to diabetes status in patients with heart failure and preserved ejection fraction. 3 Does COPD cause reduced chest expansion? Left-sided pneumothorax.An acutely ill patient with dyspnea, hypotension, unilateral finds of reduced chest expansion, a hyperresonant percussion note, absence of breath sounds and tactile fremitus, and a tracheal shift most likely has a large pneumothorax on the affected side. Examination of the neck veins can detect a central venous pressure elevation of 8 cm with a positive likelihood ratio of 9.7 and a corresponding negative likelihood ratio of 0.3.2326 Detecting a jugular venous pressure elevation of 12 cm results in a positive likelihood ratio of 10.4 and a negative likelihood ratio of 0.1 (Table 5).23,24, In summary, an elevated jugular venous pressure on examination is a good test to rule in an elevated central venous pressure, and its absence is a good sign in ruling out an elevated central venous pressure. To measure it, put the index finger of your right hand on the patients trachea against the inferior edge of the cricoid cartilage. How to Market Your Business with Webinars? Use the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue to assess the various characteristics of the lymph nodes. pulmonary embolism, which is caused by a blood clot and is a blockage in the lung arteries . self-mobilization on chest expansion and pulmonary function in healthy adults. Asbestos is a natural mineral that was used for100 years in industries like construction, shipbuilding and manufacturing. 00:29 Demonstration Compressive atelectasis may result after a diaphragmatic hernia, when a part of an organ from the abdominal cavity goes into the chest cavity, near the lungs. This information can help the doctor identify the type of lung disorder. Many restrictive lung diseases are incurable, but a range of treatments and management strategies can reduce the symptoms and enhance the quality of life. These patients have a very high FRC and have limited capability to expand the chest from this position. Tactile vocal fremitus is an alternative method of assessing the conduction of sound through lung tissue and involves feeling for sound vibrations on the chest wall with your hands as the patient speaks. What is the cricosternal distance and tracheal tug? The Mann-Whitney U test was used to compare the two groups at the Reduced airflow from restrictive diseases such as fibrosis can also be a contributing factor, according to MedlinePlus. The physical finding with the highest positive likelihood ratio for diagnosing pneumonia is asymmetry in chest expansion. What are the respiratory causes of clubbing? 2. Results: The median and mean chest expansion (+/- 2 SD) were 5.0 cm and 5.6 cm (+/- 3.52) for the whole group of healthy adolescents, 6.0 cm and 5.9 cm (+/- 3.64) for boys and 5.0 cm and 4.8 cm (+/- 2.69) for girls. Medical professionals classify restrictive lung diseases into two groups, depending on whether the cause is intrinsic or extrinsic. However, the intervention applied in the Assess for evidence of pittingsacral and pedal oedema (e.g. Whilst still palpating the radial pulse (but no longer counting it). asthma, COPD). Idiopathic pulmonary fibrosis is a chronic, progressive condition that affects the lungs. Boha-dana et al pointed out that crackle can be defined acoustically but does not suggest any means or site of generation.4 Pooled data from 4 studies in 3,647 patients6,1012 result in a positive likelihood ratio for crackles in the diagnosis of pneumonia of only 3.2. Hypoxia/ hypoxemia Diagnosis Chest X-ray [2] [24] Bronchoscopy [25] CT Scan [25] This may be Licence: Adapted by Geeky Medics. performed by the subjects in a non-clinical environment5). expiratory volume in one second (FEV1,), FEV1/FVC, peak expiratory Cystic fibrosis also affects lung development, due in part to recurrent bouts of bacterial infection. Some of the common causes of diminished breath sounds on a physical exam are heart failure, pneumonia and chronic obstructive pulmonary disease exacerbation. Inspect the face for any signs relevant to the respiratory system: Inspect the eyes for signs relevant to the respiratory system: Inspect the mouth for signs relevant to the respiratory system: Closely inspect the chest wall for scars and other abnormalities: Inspect for evidence of chest wall deformities: Gently assess the position of the trachea, which should be central in healthy individuals (this can be uncomfortable, so warn the patient in advance): 1. Restrictive diseases stop the lungs from fully expanding. 00:00 Introduction Chest expansion is typically examined posteriorly, with the thumbs placed together along the midline of the spine and the 4 fingers held together with the index finger below the 10th rib (Figure 1). Check out our NEW quiz platform at app.geekymedics.com, To be the first to know about our latest videos subscribe to our YouTube channel . Reduced chest expansion on the ipsilateral side These patients may be having secondary injuries if the cause was trauma. respectively in the TSMG, and were 22.36 3.26years, 165.50 7.37cm, and 65.09 For most of these conditions, there is no cure, but a person can manage the symptoms with medication and physical therapy. group showed a statistically significant decrease in low costal region measurements This limits the volume of air and amount of oxygen that a person breathes in. The presence of this continuous column of blood means that changes in right atrial pressure are reflected in the IJV (e.g. The diagnostic value of history, physical examination and some blood tests, Clinical prediction rule for pulmonary infiltrates, Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department, Diagnosis of pneumonia in adults in general practice. A distance of fewer than 3 fingers suggests underlying lung hyperinflation (e.g. These interventions enhanced pulmonary function and thoracic Included is detail on types and complications. 7 Can a pleural disease cause a decrease in chest expansion? abnormality. [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=1/1][vc_wp_rss items=7 title=Read the Latest Mesothelioma News: url=https://mesotheliomaresearchnews.com/category/news-posts/feed][/vc_column][/vc_row]. What causes chest asymmetry? Although many interventions have been applied in previous studies What causes decrease in chest expansion in COPD patients? In the case of reduced chest expansion, there are also other procedures that address pleural effusions. Thoracic self-mobilization, Chest expansion, Pulmonary function, The effect of thoracic joint mobilization and It results from turbulent air flow in the larynx or lower in the bronchial tree and implies obstruction at these (upper airway) levels. If you're right-handed and perform most of your tasks with your right side, you . Diagnostic value of the physical examination in patients with dyspnea, Access, Equity, and Neutral Space: Telehealth Beyond the Pandemic, Physical Examination -- Still Relevant in Sjogren Syndrome, DOI: https://doi.org/10.3949/ccjm.84a.16127, Chapter 10. The magnitude of these alterations depends on the pleural fluid volume and the underlying disease of the respiratory system. Decreased breath sounds in the region of atelectasis and possibly dullness to percussion and decreased chest excursion are detectable if the area of atelectasis is large. The normal level of fluid is the equivalent to about a couple of teaspoons and when it is exceeded, the body can naturally expel it. What is the average size of a kitchen trash can? Please write a single word answer in lowercase (this is an anti-spam measure). Click here for mnemonics on how to remember the causes of fibrosis. Reduced chest expansion can be caused by lung collapse, pneumonia and restrictive lung disease. Thus, it is not a good screening test, but it is a good diagnostic or confirmatory test. What are the causes of dullness to percussion on respiratory examination? While the patient is in maximal expiration, place your palms over the patient's posterolateral ribs with your thumbs touching in the midline. Unilaterally decreased expansion is a useful finding as the pathology is invariably on the side of decreased expansion; Question 6. Ask the patient to tilt their head (bring their ear towards their shoulder) each side in turn, and palpate behind the posterior border of the clavicle in the supraclavicular fossa (supraclavicular and infraclavicular lymph nodes). present study, no significant change in pulmonary function was observed. Mechanically ventilated patients with tension pneumothorax will present with Increased ventilation pressure Reduced air flow Tachycardia, hypotension Rapid decrease in SpO2 Diagnosis and investigations COPD does not cause clubbing. About 20% of the cases occur in the lining of the abdomen and it is known aspericardial mesothelioma, while pericardial mesothelioma refers to the disease in the lining of the heart and testicular mesothelioma occurs in thetunica vaginalistestis. In healthy individuals, it is typically located in the 5th intercostal space in the midclavicular line. present study resulted in larger increases in axillary region and sternum region The interobserver agreement for examining neck veins has a wide range of kappa scores (0.080.81), whereas the abdominojugular reflux has a very high kappa score of 0.92.7 Interestingly, chest radiography showing interstitial edema has a kappa of 0.83.7. Breathe out for two seconds through pursed lips while pressing on your abdomen. pain, The effects of thoracic mobilization on pain, disability There were no objects or medical equipment around the bed of relevance., The hands had no peripheral stigmata of respiratory disease and were symmetrically warm. An important part of a PFT involves measuring total lung capacity the gold standard for diagnosing restrictive lung disease. Any lung or pleural disease can give rise to a decrease in overall chest expansion. Peripheral pallor. Third, auscultate the chest to elicit normal, diminished, or adventitious breath sounds. This is the total volume of air that the lungs take in on maximum inhalation. Asymmetry in chest expansion: Specific, reproducible, but not sensitive. The decrease in lung volume is . in Table 1. tapeline in an upright sitting position. 1. Aurora Bakalli, Tefik Bekteshi, Merita Basha, Afrim Gashi, Afrdita Bakalli and Petrit Ademaj. The study was approved by the Berdal G, Halvorsen S, van der Heijde D, et al. overall chest expansion. Inspect the patient from the end of the bed whilst at rest, looking for clinical signs suggestive of underlying pathology: Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: The hands can provide lots of clinically relevant information and therefore a focused, structured assessment is essential. predicted pulmonary function. In about 70% of cases, mesothelioma develops in the lining of the lungs, known as the pleura, and it is calledpleural mesothelioma.
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