BMJ Case Reports

Our medical research library holds 30 studies published in BMJ Case Reports (2009–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 25 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 1 study PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: BMJ Pub. Group
• Published: 2008 to the present, England
• Language: English
• ISSN: 1757-790X (electronic)
• Its record in the NLM Catalog

2020s

• Primary malignant mesothelioma of the tunica vaginalis presenting as hydrocele: imaging pitfalls. J. Naidu, N.G. Joseph, M. Mohammed, et al. 2026;19(10). Case report PubMed · Publisher · Free full text

  Abstract

  A man in his late 70s presented with progressive, painless scrotal swelling. The initial ultrasound was reported as a simple hydrocele, and he was scheduled for surgery. At operation, friable nodules on the tunica vaginalis were biopsied, confirming malignant epithelioid mesothelioma. Staging CT showed no pleural or peritoneal disease, supporting a primary tunica vaginalis origin. As the tunica vaginalis is an embryological continuation of the peritoneum, it is exceptionally rare for mesothelioma to arise here as a true primary rather than as a secondary spread from the peritoneum. This case highlights a rare primary malignant mesothelioma masquerading as a hydrocele, the limitations of ultrasound as a sole diagnostic tool and the importance of maintaining suspicion when operative findings are discordant with imaging.

  © BMJ Publishing Group Limited 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

• Riociguat as inpatient rescue therapy for acute decompensation of inoperable chronic thromboembolic pulmonary hypertension. R.H. Alsufyani, S. Imran, B. Mccullagh, et al. 2026;19(9). Case report PubMed · Publisher · Free full text

  Abstract

  A man in his 70s, a retired coal miner with prior asbestos exposure and no smoking history, presented with syncope and progressive exertional dyspnoea. Initial CT pulmonary angiogram (CTPA) revealed bilateral lobar pulmonary emboli, and transthoracic echocardiography (TTE) showed evidence of pulmonary hypertension. He was discharged on rivaroxaban and referred to the heart failure and respiratory clinic. At the respiratory clinic follow-up, he reported worsening breathlessness and was initiated on long-term oxygen therapy (LTOT). Outpatient investigations were arranged, including a ventilation/perfusion (V/Q) scan, which demonstrated extensive mismatched perfusion defects consistent with chronic thromboembolic pulmonary hypertension (CTEPH). He was also referred for right heart catheterisation (RHC) and to the Irish National Pulmonary Hypertension Unit.Before he was reviewed in the pulmonary hypertension unit, he re-presented to the emergency department with worsening dyspnoea, haemoptysis and bilateral lower limb oedema, with clinical signs of right heart failure. Repeat imaging with TTE and CTPA confirmed persistent findings of chronic embolic disease. Despite optimal diuresis and anticoagulation, his symptoms remained refractory and required high-flow oxygen without decreasing requirements after 14 days. Riociguat was initiated and titrated inpatient, resulting in rapid clinical improvement and reduced oxygen requirement within 72 hours. Subsequent right heart catheterisation confirmed inoperable CTEPH. He was reviewed at the National Pulmonary Hypertension Clinic, and following multidisciplinary discussion, given insufficient surgically accessible thromboembolic burden and coexisting left ventricular dysfunction, the decision was made to continue riociguat as long-term medical therapy.

  © BMJ Publishing Group Limited 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

• Leucine-rich glioma-inactivated protein 1 antibody-positive limbic encephalitis in a patient with an early-stage asymptomatic breast cancer. M.F. Niño Uribe, G. Van Cutsem, P. Kerschen. 2025;18(4). Case report PubMed · Publisher · Free full text

  Abstract

  Our patient is a woman who developed a subacute amnestic syndrome, followed by cognitive impairment, headache, temporal lobe epilepsy and hyponatraemia. An early-stage asymptomatic breast cancer was identified on positron emission tomography (PET) scan. After treatment with immunotherapy with high-dose corticosteroids, intravenous immunoglobulins, upfront rituximab and excision of the tumour, the patient gradually recovered. Partial retrograde and anterograde amnesia persisted during the initial weeks, followed by slow and steady improvement. Autoimmune encephalitis is a severe neurological disorder associated with antibodies against neuronal cell-surface or intracellular onconeural proteins. Anti-leucine-rich glioma inactivated 1 (LGI1) predominantly affects males in the seventh decade of life, and less than 10% of all cases are associated with cancer. Paraneoplastic cases have been associated with malignant thymoma, neuroendocrine tumours and mesothelioma and usually had Morvan syndrome, in which serum antibodies are more frequently directed against CASPR2 than against LGI1. We report the first well-documented case of anti-LGI1 limbic encephalitis in a woman with newly diagnosed breast cancer.

  © BMJ Publishing Group Limited 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

• Malignant pleural mesothelioma. P. Rao D, S. Vijayan, S.S. Vananjakar, et al. 2025;18(2). Case report PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma is a rare and aggressive tumour of the pleura, commonly linked to asbestos exposure. However, its diagnosis is challenging, especially without known exposure. We present the case of a woman in her early 70s with no history of asbestos exposure, who presented with progressive breathlessness and left-sided chest pain. Radiological assessment revealed a large pleural effusion and nodular pleural thickening. Malignant pleural mesothelioma was confirmed through histopathological analysis of biopsies obtained via medical thoracoscopy. The patient was initiated on a palliative chemotherapy regimen, underwent talc slurry pleurodesis for recurrent effusion, and is currently under follow-up. This case emphasises the importance of a high index of suspicion for malignant pleural mesothelioma in patients with unexplained pleural effusion, even in the absence of typical risk factors, and the need for a timely diagnosis due to the disease's dismal prognosis.

  © BMJ Publishing Group Limited 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.

• Melanoma of the pleura mimicking malignant mesothelioma: a rare and rapidly progressive pleural disease. B. Edland, C. Stanley, F.H.X. Yap, et al. 2025;18(1). PubMed · Publisher · Free full text

• Detailed clinical course of a patient with rapidly progressing sarcomatoid pleural mesothelioma without p16 deletion with systemic haematogenous metastasis to soft tissues. K. Mizuhashi, K. Okamoto, K. Nabeshima, et al. 2024;17(2). Case report PubMed · Publisher · Free full text

  Abstract

  Sarcomatoid mesothelioma is difficult to differentiate from other mesotheliomas. Here, we describe the case of a man in his early 80s with sarcomatoid mesothelioma and a history of asbestos exposure. He initially presented with right-sided chest pain and was examined. Right-sided pleural effusion was detected; therefore, he was hospitalised. Based on the observed pleural effusion and biopsy result, the presence of a malignant tumour was excluded; hence, he was diagnosed with benign asbestos pleurisy. He subsequently developed left-sided pleural effusion, masses and lung nodules, and died 9.5 months after the initial examination. A definitive diagnosis of sarcomatoid mesothelioma with rapid systemic progression was established after detailed investigations using autopsy specimens. This rare case of mesothelioma-without p16 deletion (detected using fluorescence in situ hybridisation)-presented differently from the usual sarcomatoid mesothelioma.

  © BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.

• Complete clinical remission of malignant peritoneal mesothelioma with systemic pemetrexed and bevacizumab in a patient with a BAP1 mutation. J. Lee, J. Turetsky, E. Nasri, et al. 2023;16(12). Case report PubMed · Publisher · Free full text

  Abstract

  Malignant peritoneal mesothelioma (MPeM) is a rare malignancy with historically poor prognosis. Recent research has started to reveal increasingly prevalent genetic mutations seen in this malignancy. Here, we report a case of complete clinical remission of unresectable, metastatic MPeM with systemic chemotherapy. Immunohistochemistry of our patient's malignant cytology sample showed loss of Breast Cancer Gene 1-associated protein-1 expression (BAP1). The patient had synchronous diagnoses of primary squamous cell carcinoma of the anus, benign schwannoma and meningioma. Following the completion of 18 cycles of pemetrexed and bevacizumab, the patient has remained in clinical remission for 8 months. We examine the unusual susceptibility of unresectable MPeM to systemic chemotherapy and attribute susceptibility to the molecular milieu created by mutations in multiple DNA repair pathways. We encourage increased testing for and analysis of mutations in DNA repair pathways to improve future treatment outcomes in this rare malignancy.

  © BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• Donut sign: a unique radiological sign of cerebral metastasis in malignant mesothelioma. O. Adeyinka, A. Dower, Y. Li. 2022;15(10). Case report PubMed · Publisher · Free full text

  Abstract

  A man in his 70s presented to the emergency department with a 3-day history of confusion and right-facial droop. He was diagnosed with stage IIIB (T4N2M0) malignant mesothelioma 6 months previously for which he was being given palliative chemotherapy. An MRI of the brain demonstrated a left parietal cerebral metastasis with unique radiological characteristics termed 'donut sign'. He underwent a craniotomy and complete macroscopic resection of the lesion with a good postoperative outcome. Mesothelioma cerebral metastases are a rarely reported clinical entity, with only a handful of case reports and case series available. On MRI they often demonstrate a distinctive thick-walled lesion, termed 'donut sign', that may be indicative of the diagnosis. Furthermore, case autopsy series suggest these metastases may be underdiagnosed in the clinical setting due to the dismal prognosis. With newer and more effective neoplastic treatment strategies emerging, there may be a rising incidence of central nervous system metastases in the future.

  © BMJ Publishing Group Limited 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• Abdominal pain as an initial symptom of isolated ACTH deficiency induced by nivolumab in a patient with malignant mesothelioma. K. Hata, C. Sakaguchi, M. Tsuchiya, et al. 2021;14(7). Case report PubMed · Publisher · Free full text

  Abstract

  Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

  © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• Cerebral air embolism after indwelling pleural catheter insertion in a chronic hydropneumothorax secondary to epithelioid mesothelioma. D.M.C. Jayawardena, R.K. Panchal, S. Agrawal, et al. 2021;14(7). Case report PubMed · Publisher · Free full text

  Abstract

  A 75-year-old man with a history of epithelioid mesothelioma and a right-sided indwelling pleural catheter (IPC) presented with a history of a purulent fluid drainage via the IPC. The pleural fluid cultured Klebsiella oxytoca and Enterococcus faecalis He was treated with a course of oral fluoroquinolone followed by uneventful IPC replacement. One and half hours postprocedure, the patient had a witnessed drop in conscious level accompanied by seizure like activity. Acute stroke was suspected and a CT head was performed. CT head revealed multiple serpiginous pockets of air along the cerebral fissure, with features that were highly suggestive of cerebral air embolism and multiple wedge-shaped areas of infarction involving the cerebral hemispheres. Further imaging revealed satisfactory position of the replaced IPC. The patient was admitted to the intensive care unit for high flow oxygen therapy and head down ventilation. However, his condition deteriorated and he died later.

  © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• War journalism: an occupational exposure. N. Magnavita, M.T. Congedo, R.R. Di Prinzio, et al. 2021;14(10). Case report PubMed · Publisher · Free full text

  Abstract

  Apart from the risk of accidents, war theatres present a hazard related to numerous long-lasting toxic agents. For 10 years, a >60-year-old male journalist worked in war theatres in the Far and Near East where he was exposed to asbestos and other toxic substances (metals, silica, clays, polycyclic aromatic hydrocarbons and other organic substances) contained in dust and smoke of destroyed buildings. More than 15 years later, he developed a mucoepidermoid carcinoma of the soft palate and, subsequently, a pleural malignant mesothelioma. The safety of war journalists should focus not only on preventing the risk of being killed, but also on providing protection from toxic and carcinogenic agents. Exposure to substances released during the destruction of buildings can also pose a carcinogenic risk for survivors.

  © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure. S.T. Ahmed, M. Barvo, N. Kamath, et al. 2020;13(2). Case report PubMed · Publisher · Free full text

  Abstract

  A 75-year-old man presented to the emergency department with 1-day history of right lower limb pain and 3-month history of vague abdominal pain. In the emergency department a thrombus was discovered in the right popliteal artery. CT scan of the abdomen and pelvis revealed high-density material in the pelvis, multiple hypodensities on the liver, ascites with omental nodularity, and high-density material along the stomach wall. He underwent thrombectomy and was started on anticoagulation therapy. The core needle biopsy revealed primary omental mesothelioma. There was no history of any known asbestos exposure. He also had to undergo therapeutic paracentesis twice due to abdominal distension. Mesothelioma treatment of carboplatin and pemetrexed was started, and the patient is currently receiving this chemotherapy treatment regimen.

  © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

• Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion. C.A. Hinkamp, S.N. Dalal, Y. Butt, et al. 2020;13(1). Case report PubMed · Publisher · Free full text

  Abstract

  Malignant mesothelioma is an uncommon form of neoplastic transformation of the mesothelial cells that line the serosal surfaces of the body. It most commonly affects the pleura and is often associated with pleural effusions and pleural-based masses. The annual incidence in the United States is only 3300 cases, representing less than 0.3% of all cancers worldwide, although this is likely underestimated. We present a case of diffuse epithelioid malignant pleural mesothelioma in a patient with remote, short-term asbestos exposure complicated by recurrent left-sided hydropneumothoraces and pleural-based invasion of the T12 vertebral body, which represent two rare coexisting complications. This case illustrates the importance of maintaining a broad differential for hydropneumothorax, particularly as the risk factors may be decades removed and the degree of asbestos exposure to induce a malignant mesothelioma may be smaller than has been traditionally thought.

  © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

• Nivolumab for malignant peritoneal mesothelioma. T. Tanaka, Y. Miyamoto, A. Sakai, et al. 2020;13(11). Case report PubMed · Publisher · Free full text

  Abstract

  Malignant peritoneal mesothelioma (MPeM) is a highly malignant neoplasm of the peritoneum, which carries a poor prognosis. A 70-year-old man, who was employed in the shipbuilding industry and exposed to asbestos for 50 years, was found to have a low-density lesion in the peritoneum around the liver and spleen, associated with multiple mediastinal and parasternal lymphadenopathy. Laparoscopic exploration was performed, and biopsy specimen analysis led to a diagnosis of MPeM. Initial systemic chemotherapy comprising cisplatin and pemetrexed yielded a modest cytoreductive effect. However, 4 months later, the patient presented with abdominal distension and anorexia. CT images revealed massive ascites, bowel obstruction and an enlarged intra-abdominal tumour, which was considered progression of the MPeM. The patient was treated with nivolumab. Bowel obstruction was improved after the first administration, and his sense of abdomen distension completely disappeared after the third administration. This case supports the utility of immunotherapy in MPeM.

  © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

2010s

• A case from India of pleural malignant mesothelioma probably due to domestic and environmental asbestos exposure: a posthumous report. V. Muralidhar, P. Raghav, P. Das, et al. 2019;12(3). Case report PubMed · Publisher · Free full text

  Abstract

  India is the largest consumer of asbestos in the world. There is no report from India of mesothelioma related to asbestos. The case is a 42-year-old man who died of pleural mesothelioma. He was exposed to asbestos domestically and from the environment since birth. Two of his close family members worked in a factory that used asbestos. The living quarter of the family was within the premises of the factory. Asbestos waste was strewn on the grounds surrounding the quarters. After decades of legal battles by workers and families exposed to asbestos, Indian courts have ordered remedial measures and compensation to people, who are exposed to asbestos at work and the environment. Mesothelioma, currently in epidemic proportions in the west where asbestos production was banned in the 1990s, could rise to alarming levels in the next decades in India if the legal remedial measures are not implemented soon.

  © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

• Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum. J.E. Bousema, K.M. van de Luijtgaarden, S. Wilhelmus, et al. 2019;12(8). Case report PubMed · Publisher · Free full text

  Abstract

  Acute abdominal pain is a common symptom in young women. We describe a patient with acute illness and severe lower abdominal pain. Laboratory tests were normal except for mildly deranged inflammatory markers. No abnormalities were reported on abdominal ultrasonography and MRI, whereas diagnostic laparoscopy revealed a tumour located dorsally from the uterus. We resected the tumour and pathology results showed a well-differentiated papillary mesothelioma of the peritoneum (WDPMP). Microscopy showed evidence of acute ischaemia in the resected lesion, which was likely the cause of the acute abdominal pain. WDPMP is a rare disease that arises from the serous membranes which does not seem to have a relation to asbestos exposure. Generally, WDPMP has a mild clinical course and good long-term prognosis.

  © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

• Malignant deciduoid mesothelioma: a rare variant of epithelioid mesothelioma. L. Taylor, D. Cooper, A. Aujayeb. 2019;12(7). Case report PubMed · Publisher · Free full text

  Abstract

  We describe a case of a deciduoid mesothelioma, a rare variant of epithelioid mesothelioma, which is associated with a very poor prognosis. A review of the relevant literature is also included. The patient was a man with probable asbestos exposure and presented with classic features of pleural malignancy. Diagnosis was reached with close correlation between clinical, radiological and pathological findings.

  © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

• Usefulness of new flex-rigid pleuroscopy in the diagnosis of malignant pleural mesothelioma. S. Ishii, Y. Ishii, T. Kaburagi, et al. 2019;12(1). Case report PubMed · Publisher · Free full text

• Challenging and uncommon diagnosis of long-evolution ascites. M. Gravito-Soares, E. Gravito-Soares, J. Almeida, et al. 2017;2017. Case report PubMed · Publisher · Free full text

  Abstract

  This is a case report of a 45-year-old Caucasian man with chronic alcoholism. No history of liver disease or asbestos exposure. He complained of ascites during the last 3 years with worsening in the last year with severe ascites development. Diagnostic paracentesis showed SAAG 1.1 and high cellularity with neutrophil count >250 cells/µL. Ascitic fluid cytology revealed reactive mesothelial hyperplasia. Thoracoabdominopelvic ultrasonography/CT/MRI and fludeoxyglucose positron emission tomography/CT showed 'omental cake' pattern suggesting peritoneal carcinomatosis. An exploratory laparoscopy revealed moderate interloop adhesions and necrosis with whitish exudate in the right pelvic excavation. Biochemical/cytological/histological/microbiological study only revealed reactive mesothelial cells, necrosis and lymphohistiocytic inflammatory infiltrate. A second exploratory laparoscopy with liver and peritoneal biopsies and appendectomy/mesoappendix excision showed a well-differentiated tubulopapillary mesothelioma. The patient was referred for intraperitoneal chemotherapy and is undergoing monthly therapeutic paracentesis.

  © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

• Parenchymal asbestosis due to primary asbestos exposure among ship-breaking workers: report of the first cases from Bangladesh. V. Muralidhar, M.F. Ahasan, A.M. Khan. 2017;2017. Case report PubMed · Publisher · Free full text

  Abstract

  We report for the first time asbestosis among ship-breaking workers of Sitakunda in Bangladesh who were exposed to asbestos during ship-based and beach-based operations for at least 10 years. Asbestosis was present among 35% of workers. Years of work (>20) and forced vital capacity (<80% of predicted) were significantly associated with the disease. Currently, global ship-breaking operations are mainly concentrated in the Indian subcontinent, and Bangladesh has the majority share. Ninety per cent of domestic steel is produced in the ship-breaking operations in Bangladesh and is an important contributor to the economy. It also gives employment to more than 100 000 people. It is imperative to medically check up all the workers for benign and malignant diseases causally related to asbestos among these vulnerable population of workers.

  © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

• Primary pericardial mesothelioma and asbestos exposure: a rare fatal disease. D.M.M. Freitas, R.L. Ramos, L. Serpa Pinto, et al. 2017;2017. Case report PubMed · Publisher · Free full text

  Summary

  This short 'Images In' case report from internal medicine physicians at a hospital in Porto, Portugal, described a 73-year-old woman with no history of cardiovascular disease. She was admitted with several weeks of worsening breathlessness on exertion, swelling of both legs, breathlessness when lying flat and breathlessness waking her at night. For 50 years she had lived a few metres from a badly preserved building containing asbestos. Probrain natriuretic peptide was 2304 pg/mL. A chest radiograph showed a globular heart shadow and a small transudative pleural effusion; cytology of the pleural fluid found benign mesothelial cells. Echocardiography showed a large pericardial effusion with diastolic collapse of the right ventricle and a 4×1.6 cm mass attached to the visceral pericardium. Fluid drained from the pericardium contained malignant cells of inconclusive origin. CT, mammography and endoscopies found no disease outside the heart. PET-CT showed isolated uptake in the apex and right atrium. The effusion recurred, and pericardiectomy was performed four days after admission. Histology showed primary pericardial malignant mesothelioma. She was treated with carboplatin and pemetrexed, her disease progressed, and she died one year after diagnosis. The authors noted that this tumour is extremely rare and uniformly fatal. They emphasised her asbestos exposure, stating that this association remains controversial and has rarely been reported without concomitant pleural disease.

  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.

• Minimal change disease associated with malignant pleural mesothelioma: case report and review of the literature. H. Yildiz, S.I. Andreea, D. Hoton, et al. 2016;2016. Case report · Review PubMed · Publisher · Free full text

  Abstract

  A 77-year-old man with a history of asbestos exposure was admitted to our internal medicine division for generalised weakness, fatigue, loss of weight, night sweats and difficulty for breathing since 3 months. Clinical examination revealed left fine crackles and bilateral leg oedema. Blood test showed elevated C reactive protein level at 142 mg/L, lactate dehydrogenase level at 421 UI, creatinine level at 5.75 mg/dL. Serum albumin level at 30 g/L, urinalysis showed significant proteinuria at 6.4 g/L. Chest X-ray showed left pleural effusion. Renal ultrasonography was normal. Thoracic CT and positron emission tomography showed mediastinal enlargement with lymphadenopathies and left pleural effusion and thickening. A pleural biopsy showed features compatible with malignant epithelioid mesothelioma. Renal biopsy showed minimal change disease and acute tubular necrosis. A diagnosis of malignant mesothelioma associated with minimal change disease and acute tubular necrosis secondary was then made. Given the poor general condition, palliative care was initiated and the patient died from respiratory failure 3 months later.

  2016 BMJ Publishing Group Ltd.

• Severe case of asbestos-related lung diseases. P. Tunsupon, P. Yampikulsakul. 2016;2016. Case report PubMed · Publisher · Free full text

• The journey of mesothelioma: from postmortem to FNA. M. Gorecka, J. Scott, R. Casey, et al. 2014;2014. Case report PubMed · Publisher · Free full text

  Abstract

  A 73-year-old man, non-smoker presented with an 8-week history of left-sided chest pain and shortness of breath on exertion. He had no significant medical history. He worked in construction for 40 years, but denied definite asbestos exposure. His initial chest X-ray demonstrated a large left-sided pleural effusion. Subsequent CT thorax revealed circumferential thickening of the pleura with associated pleural plaques and calcification. A provisional diagnosis of mesothelioma was made. Initial ultrasound-guided thoracocentesis revealed a transudate with negative cytology. In addition, thoracoscopy and CT-guided pleural biopsy failed to obtain a definitive diagnosis. A surgical biopsy was planned, but at the time of admission, the patient developed unilateral neck swelling. Ultrasound-guided fine-needle aspiration (FNA) and core biopsies of the lymph node were diagnostic for pleural mesothelioma. Treatment with palliative chemotherapy was planned, but the patient's clinical status rapidly deteriorated and he passed away prior to the beginning of therapy.

• Asbestos-related pleural plaques: significance and associations. R. Abeyratne, P. Wills, S.W. Dubrey. 2013;2013. Case report PubMed · Publisher · Free full text

• Chronic empyema: importance of preventing complications in the management of pleural effusions. V. Molander, M. Diakopoulou, L. Orre, et al. 2013;2013. Case report PubMed · Publisher · Free full text

  Abstract

  We report a case of chronic empyema in a 63-year-old man with a history of asbestos exposure and alcohol overconsumption. In 2009, he presented with dyspnoea, exudative pleurisy on the right side with no symptoms of infection or malignancy. In 2013, the patient presented with increased dyspnoea and a massive chronic empyema had evolved. Culture of the pleural fluid was positive for Escherichia coli and anaerobic bacteria, and he was treated with antibiotics, chest drainage as well as surgical evacuation. After surgery, as the lung failed to expand, growth of opportunistic bacteria and rising C reactive protein obliged long-time treatment with broad-spectrum antibiotics as well as chest drainage with daily saline flushes. The patient still suffers from fatigue, poor nutritional status and anaemia, and further treatment with chest drainage and antibiotics is planned. Advanced chronic empyema is a difficult condition with poor response to treatment, and diagnostic delay is the main cause of complications.

• Diagnostic delay in malignant pleural mesothelioma due to physicians fixation on history with non-exposure to asbestos. P.H. Madsen, C.B. Laursen, J.R. Davidsen. 2013;2013. Case report PubMed · Publisher · Free full text

  Abstract

  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.

• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma. H.E. Fayed, V.K. Woodcock, J. Grayez. 2013;2013. Case report PubMed · Publisher · Free full text

  Abstract

  This is a case of a 69-year-old man with a history of asbestos exposure who presented with acute shortness of breath. His chest x-ray showed bilateral hydropneumothorax. Further investigations including CT chest and video-assisted thoracoscopic surgery revealed bilateral pleural thickening and histology confirmed epithelioid mesothelioma. This case highlights the need for clinicians to be aware of atypical presentations of malignant pleural mesothelioma as well as the importance of considering underlying secondary causes such as malignancy in the older patient presenting with spontaneous pneumo/hydropneumothorax.

2000s

• Retroperitoneal and pleural fibrosis in an insulator working in power plants. T. Uibu, M. Jäntti, R. Järvenpää, et al. 2009;2009. PubMed · Publisher · Free full text

  Abstract

  We describe a case history of a former insulator who developed concomitant retroperitoneal and pleural fibrosis. In his work, the patient had been exposed on a daily basis to asbestos dust while demolishing and installing pipeline insulations. The heavy asbestos exposure was confirmed by a high level of asbestos content in his autopsy lung sample. We propose that both retroperitoneal fibrosis and diffuse pleural thickening were induced in our patient by an abundant amount of amphibole asbestos fibres found in his lung and retroperitoneal tissues.

• Syndrome of pleural and retrosternal "bridging" fibrosis and retroperitoneal fibrosis in patients with asbestos exposure. V. Cottin, P.Y. Brillet, F. Combarnous, et al. 2009;2009. PubMed · Publisher · Free full text

  Abstract

  Two case histories are described of pleural and anterior mediastinal fibrosis presenting as a continuous fibrotic process with thick parietal pleural plaques extending from one pleura to the contralateral pleura through the retrosternal area, and with retroperitoneal fibrosis. Follow-up over 4 years in one case demonstrated rapid progression of disease, with pleural fibrosis preceding retrosternal and retroperitoneal fibrosis. Histopathological analysis in both cases showed non-tumoral fibrosis with broad fibrous bundles surrounding fibroblasts (and lymphocytes in one case). Possible causes such as infections and exposure to ergot derivatives were excluded. Both patients had been slightly or moderately exposed to asbestos.

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