A Man in His 20s With Cough, Unilateral Pleural Effusion, and Nodular Pleural Thickening

Our plain-English summary of A Man in His 20s With Cough, Unilateral Pleural Effusion, and Nodular Pleural Thickening, by M.A. Sonnick, S. Weisman, A.C. Borczuk, et al (Chest, 2019).

The study

• Authors: M.A. Sonnick, S. Weisman, A.C. Borczuk, M.L. Turetz
• Journal: Chest
• Published: 2019;156(6):e121-e126
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

A man in his 20s presented to the ED after several months of progressive dyspnea, dry cough, and night sweats. He had no chest pain, fevers, weight loss, or sick contacts. He was previously healthy and took no medications. Social history was notable for 5 pack-years of tobacco use. The patient was sexually active with male partners and had a recent partner infected with human T-lymphotropic virus. The patient worked in set design and window installations, and wore a respirator when working around solvents and resins. From ages 2 to 7 years, he frequently visited buildings at his parents' workplace that were undergoing asbestos abatement. From ages 7 to 24 years, he frequently visited pottery studios where talc-containing products were used. He frequently visited northern Massachusetts, and infections with Borrelia burgdorferi and Bartonella henselae were common in family members. His stepfather had recently been infected with Anaplasma. There was no family history of cancer.

Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

In plain English

This case report described one man in his 20s who came to an emergency department after several months of worsening shortness of breath, dry cough and night sweats. From ages 2 to 7 he often visited buildings at his parents' workplace that were undergoing asbestos abatement. From ages 7 to 24 he often visited pottery studios where talc-containing products were used. The report named no fiber type and did not state whether these exposures caused his illness. CT scans showed fluid and nodular thickening in the lining of the left lung (pleura). Fluid tests found no cancer cells, even on repeat sampling. Doctors first thought lymphoma most likely and considered mesothelioma unlikely because of his young age. A surgical biopsy (VATS) showed biphasic malignant mesothelioma. Genetic testing found no BAP1 mutations, and lymph nodes in the center of the chest were not involved. He was referred for extrapleural pneumonectomy followed by chemotherapy and radiation. The authors concluded that thoracoscopic biopsy or VATS is necessary for a definitive diagnosis.

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 (single patient), published in a clinical teaching series
• Who was studied: One previously healthy man in his 20s with several months of progressive shortness of breath, dry cough and night sweats; place and dates of care not stated in the case description
• Exposure: In childhood (ages 2 to 7), frequent visits to buildings at his parents' workplace that were undergoing asbestos abatement. From ages 7 to 24, frequent visits to pottery studios where talc-containing products were used. No fiber type or dose was given. He also had 5 pack-years of tobacco use and worked in set design and window installations.
• Main results:
  • CT showed a loculated left pleural effusion and circumferential, nodular thickening of the left pleura
  • Pleural fluid cytology was negative for cancer cells at first and on repeat sampling
  • Mesothelioma was initially thought unlikely because of the patient's young age
  • VATS biopsy was consistent with biphasic mesothelioma
  • Mediastinoscopy confirmed no involvement of the mediastinal or contralateral lymph nodes
  • Genetic testing found no germline or somatic BAP1 mutations
  • The patient was referred for extrapleural pneumonectomy (EPP) followed by adjuvant chemoradiation
• The authors' conclusion: The authors concluded that mesothelioma usually cannot be told apart from lung cancer or other cancers by history, imaging and fluid cytology, and that thoracoscopic biopsy or VATS is necessary for a definitive diagnosis

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pleural Thickening, Dyspnea, Respirator, Abatement, Talc.

Related studies

• Investigating unilateral pleural effusions: the role of cytology — D.T. Arnold, D. De Fonseka, et al. (2018)
• Predicting Malignant and Paramalignant Pleural Effusions by Combining Clinical, Radiological and Pleural Fluid Analytical Parameters — S. Herrera Lara, E. Fernández-Fabrellas, et al. (2017)
• Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology — S. Savic, N. Franco, et al. (2010)
• A 70-year-old woman with dyspnea and chest pain — A. Ganesh, M. Flores, et al. (2014)
• Nodular thickening of interlobar fissures: an early manifestation of malignant mesothelioma: a case report — S. Bandoh, J. Fujita, et al. (2001)
• Clinically occult primary fallopian tube carcinoma presenting as a malignant pleural effusion — R. Hiensch, K. Meinhof, et al. (2017)

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