A case of pleural mesothelioma with effusive-constrictive pericarditis

Our plain-English summary of A case of pleural mesothelioma with effusive-constrictive pericarditis, by N.A. Weir, B. Gerstenhaber (The Yale Journal of Biology and Medicine, 2001).

The study

• Authors: N.A. Weir, B. Gerstenhaber
• Journal: The Yale Journal of Biology and Medicine
• Published: 2001;74(3):159-63
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Summary of the article

The authors described a man with malignant pleural mesothelioma who also developed benign effusive-constrictive pericarditis, a combination they stated had not been described before in the literature. The patient, a 76-year-old retired telephone installer who denied known asbestos exposure, was found to have a left pleural effusion on a chest radiograph taken before hip replacement. Thoracentesis removed 500 ml of serosanguinous fluid with no malignant cells, and CT showed pleural thickening and calcification without masses. He was considered most likely to have a benign asbestos-related effusion and was followed for two years, during which the effusions did not reaccumulate. He was then admitted with new atrial fibrillation, dyspnea on exertion, peripheral edema and weight loss. CT showed a new right pleural effusion and a moderate pericardial effusion. Echocardiography showed thickened pericardium, and heart catheterization showed equalization of diastolic pressures, leading to a diagnosis of constrictive pericarditis. At video-assisted thoracoscopy with pericardial biopsy, the parietal pleura showed malignant mesothelioma, while the pericardium showed only chronic inflammation and fibrosis. Biopsies of the peritoneum and diaphragm showed no malignancy. He declined chemotherapy and radiation and died three weeks later of respiratory insufficiency. No autopsy was performed. The authors found only one similar published case. They concluded that his death was due to benign effusive-constrictive pericarditis, more likely than not caused by asbestos.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This case report described a 76-year-old man, a retired telephone installer who denied any known asbestos exposure. A routine chest X-ray found fluid around his left lung (pleural effusion). The fluid showed no cancer cells, and a CT scan showed pleural thickening and calcification without masses, so his doctors judged it most likely a benign asbestos-related effusion. Two years later he was admitted with a new irregular heartbeat, breathlessness, swelling and weight loss. Tests showed fluid around the heart and stiffening of the sac surrounding it, which the authors called effusive-constrictive pericarditis. Biopsies showed malignant mesothelioma of the pleura, but the pericardial tissue showed only chronic inflammation and scarring. He declined chemotherapy and radiation and died three weeks later. The case description gives respiratory insufficiency as the cause, while the discussion says he died from the non-cancerous pericarditis. The authors concluded that this pericarditis was more likely than not caused by asbestos. They noted that no autopsy was done and that tumor invasion of the pericardium was conceivable.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 76-year-old man (S.H.), a retired telephone installer with a 40 pack-year remote smoking history. He was first seen after a left pleural effusion was found on a chest X-ray taken before hip replacement, and was seen at Yale School of Medicine.
• Exposure: No fiber type, product or asbestos job was identified. The patient denied any known exposure to occupational inhalants or to asbestos. Prior asbestos exposure was inferred from calcifications in the pleura seen on CT.
• Main results:
  • At first presentation, 500 ml of serosanguinous (blood-tinged) fluid was removed from the left chest. Cytology was negative for malignant cells, and CT showed pleural thickening and calcification without masses. The effusion was considered most likely a benign asbestos-related effusion.
  • Two years later the patient was admitted with new atrial fibrillation and liver enzyme abnormalities. He reported dyspnea on exertion, peripheral edema and weight loss. CT showed a new right pleural effusion and a moderate pericardial effusion.
  • Echocardiography showed the pericardial effusion, with both visceral and parietal pericardium thickened. Heart catheterization showed elevated pressures in all chambers and equalization of diastolic pressures. Constrictive pericarditis was diagnosed, and the authors describe the condition as effusive-constrictive pericarditis.
  • Biopsy of the parietal pleura was consistent with malignant mesothelioma. The pericardial tissue showed only chronic inflammation and fibrosis. Biopsies of the peritoneum and diaphragm also showed no malignancy.
  • The patient declined chemotherapy and radiation and died three weeks later. The case description states respiratory insufficiency as the cause. The discussion states he died from constrictive pericarditis that was not of malignant origin.
• The authors' conclusion: The authors concluded that the patient had asbestos-related bloody pleural effusions with later pleural mesothelioma. In their view, his death was due to a benign effusive-constrictive pericarditis that was more likely than not caused by asbestos.
• Limitations the authors state:
  • No autopsy was performed.
  • The authors acknowledged that the pericardium may have been invaded by the mesothelioma. In that case the fibrosis seen on biopsy could have been a local reaction to tumor rather than a benign process.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Pleural Effusion, Chest X-Ray, Thoracentesis, Pleural Thickening, Dyspnea, Pericardial Effusion.

Related studies

• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• Chronic constrictive pericarditis associated with asbestosis — L. Fischbein, M. Namade, et al. (1988)
• Pericardiectomy for treatment of neoplastic constrictive pericarditis — F. Buyukbayrak, E. Aksoy, et al. (2014)
• 18F-FDG PET/CT Revealing Constrictive Pericarditis as the Only Manifestation of Malignant Mesothelioma — J.P. Edel, H. Balink (2019)
• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)
• Constrictive pericarditis in a patient with fiberglass lung disease: a case report — C.Y. Hsu, H.Y. Chen, et al. (2024)

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