BMJ Case Reports 2013; doi:10.1136/bcr-2012-007491

Diagnostic delay in malignant pleural mesothelioma due to physicians fixation on history with non-exposure to asbestos

  1. Jesper Rømhild Davidsen
  1. Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr Christian B Laursen, christian.b.laursen{at}


To establish the diagnosis of virtually any disease, the clinician must combine a variety of information. Often emphasised in this context is thorough medical history-taking including information on exposure to factors leading to or being associated with the disease in question. Continuous assessment of all available information is of utmost importance, as fixation on single details can be misguiding with inappropriate consequences in both the diagnostic and therapeutic approach. This case report presents how an atypical medical history led to a delay in the diagnosis of malignant pleural mesothelioma due to a low a priori likelihood of the disease because of non-exposure to asbestos. We highlight the fact that postrationalisation and attempts to renew a diagnostic approach must be carried out each time diagnostic dilemmas emerge, and when some or all diagnostic clues disagree.

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