Advanced malignant mesothelioma mimicking acute contained thoracic aortic rupture

Our plain-English summary of Advanced malignant mesothelioma mimicking acute contained thoracic aortic rupture, by N.J. Mouawad, V.C. Daniel, J.E. Starr (Interactive Cardiovascular and Thoracic Surgery, 2014).

The study

• Authors: N.J. Mouawad, V.C. Daniel, J.E. Starr
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2014;18(2):242-4
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

In the emergent setting, patients presenting with acute interscapular pain along with haemodynamic instability require immediate evaluation. We describe the case of a patient in which computed tomographic scanning demonstrated a large hyper-dense, periaortic collection on post-contrast imaging. Urgent endovascular repair was performed for descending thoracic aortic rupture. Her postoperative course, however, was atypical with a readmission 1 week after discharge with symptoms similar to her primary presentation. Alternative pathologies were then considered in a more elective setting in which the correct diagnosis of diffuse malignant mesothelioma was ultimately discovered in a patient with no previous exposure to occupational toxins. The tumour burden was advanced and the patient opted for palliative care. Herein, we suggest a consideration for oncological thoracic pathology in patients presenting with signs and symptoms mimicking acute thoracic aortic rupture or dissection, who may demonstrate atypical symptoms.

In plain English

This case report described one patient: an 82-year-old woman who arrived at the emergency department with chest discomfort, pain between the shoulder blades and low blood pressure. The article stated she had no previous exposure to occupational toxins. A CT scan showed a 14.6 cm collection beside the descending thoracic aorta that appeared to be leaking contrast, so she had emergency stent-graft repair for a suspected contained rupture of the aorta. Her chest pain resolved, but she returned 1 week later with identical symptoms and an unchanged collection on CT. A PET/CT scan showed high metabolic activity around the aorta and in pleural nodules. At keyhole chest surgery, surgeons found pleural studding and a densely adherent mass around the aorta, but no haematoma. Tissue tests showed diffuse metastatic mesothelioma, biphasic type. She chose no further treatment and was receiving hospice care. Looking back, the authors attributed her sudden pain to bleeding within the tumour. They suggested considering cancer in the chest when patients appear to have acute aortic rupture or dissection but show atypical symptoms.

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 82-year-old Caucasian woman with hypertension, hyperlipidaemia and a heart rhythm disorder. The authors are from The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Dates of care are not given.
• Exposure: The article reports no occupational exposure: the patient had no previous exposure to occupational toxins. No fiber type, product or job is named.
• Main results:
  • A CT scan showed a 14.6 cm intermediate density collection next to the descending thoracic aorta. Post-contrast imaging suggested contrast extravasation, which was read as acute contained aortic rupture.
  • After emergency thoracic endovascular aneurysm repair (TEVAR), the patient was discharged on postoperative day 5 and her chest pain had resolved.
  • She was readmitted 1 week later with symptoms identical to her first presentation. A repeat CT showed no change in the periaortic collection.
  • At thoracoscopic surgery there was pleural studding and a densely adherent periaortic mass. No haematoma was found.
  • Histopathology confirmed malignant mesothelioma, biphasic type (described in the text as diffuse metastatic mesothelioma, biphasic type).
  • The patient requested no further therapy and was receiving hospice care.
  • In hindsight, the authors attributed the acute chest pain to haemorrhage within the tumour.
  • A retrospective review of the preoperative CT showed several subcentimetre pleural nodules that had been too small to characterize.
• The authors' conclusion: The authors suggested that cancer in the chest be considered in patients who present with signs and symptoms mimicking acute thoracic aortic rupture or dissection and who may have atypical symptoms.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Palliative Care, Pathology.

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• Thoracic Hyper-IgG4-Related Disease Mimicking Malignant Pleural Mesothelioma — F. Lococo, T. Di Stefano, et al. (2019)

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