Respiratory Medicine Case Reports

Our medical research library holds 34 studies published in Respiratory Medicine Case Reports (2014–2026). 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. 33 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Elsevier Ltd
• Published: 2011 to the present, England
• Language: English
• ISSN: 2213-0071 (electronic)
• Continues: Respiratory Medicine CME
• Its record in the NLM Catalog

2020s

• Disseminated tuberculosis secondary to polymicrobial co-infection following long-term immunotherapy for sarcomatoid mesothelioma: A case report. L. Xia, J. Xu, Z. Chen, et al. 2026;59:102367. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM), particularly its sarcomatoid subtype, is a highly aggressive sarcoma of the pleural lining with a dismal prognosis. Prolonged use of immune checkpoint inhibitors (ICIs), while improving survival in selected patients, can induce profound immunosuppression, increasing susceptibility to life-threatening opportunistic infections. This report describes a 77-year-old male with sarcomatoid MPM who developed fatal disseminated tuberculosis (TB), accompanied by concurrent Aspergillus and herpesvirus infections during extended immunotherapy. The case underscores the critical role of metagenomic next-generation sequencing (mNGS) in enabling rapid diagnosis of atypical TB reactivation in an immunocompromised host, even when conventional cultures are negative. mNGS identified co-infections with Aspergillus flavus and herpesviruses (HHV-5, HHV-4, HHV-1), demonstrating its superiority in polymicrobial infection detection.

  © 2026 The Authors.

• IgG4-related pulmonary pseudotumor and pleuritis mimicking lung cancer and asbestos plaque: A case report. R. Kamada, M. Hibino, H. Higa, et al. 2026;59:102363. Case report PubMed · Publisher · Free full text

  Abstract

  We report the case of a 70-year-old man who presented with a two-month history of cough. He had a history of asbestos exposure. Chest imaging revealed a mass on the right upper lobe, bilateral hilar and mediastinal lymphadenopathies, bilateral pleural thickening, and partial calcification of the right pleura. Lung cancer and asbestos-related pleural disease were suspected initially. However, neither transbronchial lung biopsy nor computed tomography-guided percutaneous needle lung biopsy demonstrated evidence of malignancy. Subsequent video-assisted thoracoscopic surgery revealed storiform fibrosis, dense lymphoplasmacytic infiltration, and numerous IgG4-positive plasma cells in the lung mass along with asbestos bodies. The pleura exhibited similar histopathological features. The patient's elevated serum IgG4 levels, in combination with these histological features, fulfilled both the 2019 ACR/EULAR classification criteria and the Japanese comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD). The patient was treated with oral prednisolone, resulting in resolution of the lung mass, symptom improvement, and a decline in serum IgG4 levels. IgG4-RD is an immune-mediated condition characterised by T helper type 2 cell activation, elevated serum IgE levels, and regulatory T cell (Treg) dysfunction. The development of Treg dysfunction after asbestos exposure suggests a potential mechanistic link between asbestos and the pathogenesis of IgG4-RD. This case highlights the diagnostic challenges posed by IgG4-related lung disease, which can mimic malignancy and asbestos-related pathology, underscoring the importance of biopsy for accurate diagnosis. It also suggests a possible association between asbestos exposure and IgG4-RD development.

  © 2025 The Authors.

• Hematogenous dissemination of malignant pleural mesothelioma: An autopsy case of gallbladder metastasis causing obstructive jaundice. S. Okamoto, M. Shinomiya. 2025;58:102315. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is an aggressive cancer with poor prognosis. Although hematogenous metastasis is rare, we report an autopsy case in which gallbladder metastasis had caused fatal obstructive jaundice. A 72-year-old man, who had experienced long-term exposure to asbestos, was diagnosed with epithelioid MPM. Despite immuno- and chemotherapy, the disease progressed. Nineteen months later, the patient was admitted with jaundice and renal failure. Imaging showed mild gallbladder wall thickening, but no overt obstruction. The patient died 10 days after admission. An autopsy revealed widespread metastases, including full-thickness gallbladder infiltration and bile stasis in the liver. Acute tubular necrosis of the kidneys and bile protein casts in the renal tubules suggested bile cast nephropathy. The findings of this case suggest that gallbladder metastasis from MPM may cause obstructive jaundice and multi-organ failure, potentially contributing to death. Clinicians should be aware of this rare metastatic pattern when evaluating liver dysfunction in patients with advanced MPM.

  © 2025 The Authors.

• Sarcomatoid diffuse pleural mesothelioma in an 80-year-Old woman with long-term response to nivolumab plus ipilimumab: A case report. Y. Yoshida, H. Mizugaki, Y. Sato, et al. 2025;56:102242. Case report PubMed · Publisher · Free full text

  Abstract

  An 80-year-old woman presented to our hospital with the chief complaint of left lateral thoracic pain. Chest computed tomography showed multiple nodular lesions in the left pleura and massive left pleural effusion. Based on clinical findings, imaging, and thoracoscopic pleural biopsy, a diagnosis of sarcomatoid diffuse pleural mesothelioma clinical T2N0M0 Stage IB was made. We administered nivolumab plus ipilimumab as first-line treatment, which resulted in significant reduction of pleural lesions and complete resolution of pleural effusion after two courses. No immune-mediated adverse events except fever were observed. Treatment was discontinued after 16 courses, with no disease recurrence for more than 2 years following the initial treatment. This case suggests that nivolumab plus ipilimumab can be an effective treatment option for older adults with pleural mesothelioma who maintain a good performance status.

  © 2025 The Authors. Published by Elsevier Ltd.

• A case of pleural mesothelioma with immunohistochemical staining positive for Krebs von den Lungen-6. Y. Matsumura, S. Sato, K. Haji, et al. 2024;50:102040. Case report PubMed · Publisher · Free full text

  Abstract

  A 71-year-old male visited a hospital with a chief complaint of exertional dyspnea. A chest CT revealed multiple nodular lesions on the parietal pleura. Thoracoscopic pleural biopsy was performed resulting in a diagnosis of pleural mesothelioma with epithelioid type. When chemotherapy was initially initiated, his serum level of Krebs von den Lungen-6 (KL-6) was high. However, once chemotherapy was started, the serum KL-6 level gradually decreased with tumor shrinkage. Immunohistochemical staining revealed the expression of KL-6 from the tumor cells. This is the first report of KL-6 production directly from tumor cells in epithelial-type pleural mesothelioma.

  © 2024 The Authors. Published by Elsevier Ltd.

• Isolated pulmonary amyloidoma: A rare cause of solitary pulmonary nodule. D. DeCicco, E. Alshaikhnassir, V. Deepak, et al. 2023;42:101820. Case report PubMed · Publisher · Free full text

  Abstract

  Pulmonary nodules are a frequent finding on imaging, especially given screening guidelines for lung cancer with low dose computed tomography (CT) scan. Here, we report a case with a single pulmonary nodule in a patient exposed to coal dust and asbestos. The nodule had benign features, but it showed an increase in size on repeated imaging. A CT-guided biopsy followed by mass spectrometry of the sample identified the nodule as the AL subtype of amyloidoma. A bone marrow biopsy was without evidence for malignancy including lymphoma. Nodular pulmonary amyloidosis (NPA) is rare, and a biopsy is required to establish the diagnosis. NPA generally does not affect lung function or impact survival; thus NPA does not require specific therapy. This case is the first documented case associated with coal-dust exposure. High-risk patients need to be followed longitudinally due to association of amyloidosis with lymphoma and other systemic conditions.

  © 2023 The Authors.

• A patient with epithelioid pleural mesothelioma (Myxoid variant) who survived for a long period without treatment. K. Mizuhashi, K. Okamoto, T. Kishimoto. 2021;33:101381. Case report PubMed · Publisher · Free full text

  Abstract

  Pleural mesothelioma is a disease with a very poor prognosis. Here, we report a mesothelioma patient who survived for 5 years and a half. As a result of the autopsy, the tumor was diagnosed as a myxoid variant, which is internationally proposed as a histological subtype of epithelioid mesothelioma with a relatively favorable prognosis. Since patients with this disease are expected to survive for a long period even without treatment, careful determination of the therapeutic approach is considered necessary. This report is considered to be the first of a myxoid variant epithelioid pleural mesothelioma in Japan.

  © 2021 The Author(s).

• A rare etiology of pulmonary nodules. A. Rupal, H. Singh, C. Jani, et al. 2021;34:101519. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Pulmonary nodules are a frequent finding on chest imaging studies, with differential including multiple benign entities, but malignancy is often also a concern. Computed Tomography (CT) and Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) scans have improved the characterization of pulmonary nodules. However, many nodules remain indeterminate and require periodic monitoring. Here we report two nodular pulmonary amyloidosis cases as a rare etiology of enlarging pulmonary nodules with FDG avidity.

  Case Presentation: Case 1: 75-year-old woman with a history of asthma, emphysema, bronchiectasis, and a 48 pack-year smoking history was found to have subcentimeter groundglass pulmonary nodules in the right lower lobe (RLL). Follow-up imaging demonstrated an increased solid component of a RLL bulla associated with mild FDG uptake on PET scan. A CT-guided biopsy revealed amyloid deposition. Case 2: 77-year-old man with a history of interstitial lung disease, asbestos exposure, prior tobacco use, and atrial fibrillation treated with amiodarone was found to have a 1.6cm RLL nodule. Follow-up imaging identified an interval increase to 2.0cm associated with moderate FDG uptake on PET scan. Transthoracic biopsy identified amyloid deposition.

  Discussion: Nodular pulmonary amyloidosis is a rare form of amyloidosis which may present as an enlarging pulmonary nodule with FDG avidity, raising concern for malignancy. A CT-guided biopsy is a safe way to establish a diagnosis. Recent studies have demonstrated an association between nodular pulmonary amyloidosis and marginal zone lymphomas, which warrants longitudinal follow-up for evolution to lymphoproliferative disorder.

  © 2021 The Authors.

• Localized pleural metastasis without other organ metastases after nephrectomy for renal cell carcinoma. Z. Saito, K. Hata, S. Nishioka, et al. 2021;33:101388. Case report PubMed · Publisher · Free full text

  Abstract

  We present a case of a 69-year-old man who had localized pleural metastasis without other organ metastases after nephrectomy for right renal cell carcinoma (RCC). He complained of respiratory symptoms for more than two years after the operation and was confirmed to have right pleural effusion and multiple pleural masses on computed tomography (CT). There were no abnormal findings in the other organs, but the pleural mass gradually increased in size on CT. We suspected malignant tumors such as malignant pleural mesothelioma and synovial sarcoma in addition to RCC metastasis. Finally, we performed surgical resection of the pleural mass under general anesthesia, and we diagnosed pathologically as metastasis from RCC. Distant metastases of RCC are common in the lungs, bones, brain, and liver. To our knowledge, localized pleural metastases from RCC is rare.

  © 2021 The Authors.

• Pulmonary talcosis in the setting of cosmetic talcum powder use. A. Cho, R. Amirahmadi, A. Ajmeri, et al. 2021;34:101489. Case report PubMed · Publisher · Free full text

  Abstract

  Pulmonary talcosis is a rare pneumoconiosis that is difficult to diagnose and may progress to debilitating lung disease. Four types of talcosis are described in literature: talc-silicosis and talc-asbestosis secondary to inhalation in industry workers and talc-emboli in intravenous drug users that self-inject talc-containing oral tablets. Although found in common household products, talc is overlooked as a cause of pneumoconiosis. Talcosis caused by cosmetic face powder is even rarer. Here we discuss a woman in her 50s who developed talcosis from inhalation of cutaneous cosmetics two years prior, and how comprehensive history may be crucial in diagnosing this rare disease.

  Published by Elsevier Ltd.

• Long-term benefit from immune modulation and anti-inflammatory treatment in metastatic mesothelioma. A.G. Dalgleish, E. McLean, N. Patel, et al. 2020;29:100971. Case report PubMed · Publisher · Free full text

  Abstract

  A 64 year old male heating engineer was investigated for a persistent cough and found to have epithelioid mesothelioma with pleural effusion, lung nodules and increased thoracic lymph nodes. He declined standard of care treatment following his own research and he was enrolled in a named patient programme of IMM-101. He was advised to correct his low vitamin D3 level and to start using anti-inflammatories such as aspirin, bromelain and low dose Naltrexone. At review one year later a CT scan showed no change and he continued on the regimen. Four years after the diagnosis a CT scan showed that there was a modest but definite progression of the left malignant pleural thickening, and a new right-sided effusion, enlargement of several intrathoracic nodes which had been noted on the early scans. The chest wall lump eventually broke down and required local radiotherapy. He then developed abdominal pain and found to have peritoneal disease. Last year he obtained the cannabinoids CBD and THC which slowed down the disease and a CT scan after he had been on this for six months, showed that his disease was fairly stable with marginal progression.

  © 2019 Published by Elsevier Ltd.

• Nivolumab-induced immune thrombocytopenia in a patient with malignant pleural mesothelioma. J. Sakakibara-Konishi, M. Sato, M.T. Sato, et al. 2020;31:101170. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is a rare and highly aggressive tumor. Nivolumab showed durable antitumor effect in patients with recurrent MPM and was approved for those patients in Japan in 2018. Immune related adverse event (irAE) is occurred in various organs and is suggestive to be related to better outcome of nivolumab. Frequency of hematological irAE is low and there are few reports about hematological irAE and association between irAE and outcome of nivolumab in patients with MPM. We present a case of recurrent MPM who responded to nivolumab treatment and experienced nivolumab-induced immune thrombocytopenia (ITP). Although high dose dexamethasone was administered and platelet count increased transiently, re-administration of dexamethasone was required to maintain normal count of platelet. The careful and intensive management of ITP treatment is necessary in cases who show no response or relapse to initial glucocorticoids treatment. This is the first report about nivolumab-induced ITP and association with response to nivolumab in MPM.

  © 2020 The Authors. Published by Elsevier Ltd.

• Pleural involvement of diffuse large B-cell lymphoma mimicking malignant pleural mesothelioma. T. Ito, K. Fujita, M. Okamura, et al. 2020;31:101206. Case report PubMed · Publisher · Free full text

  Abstract

  Diffuse large B-cell lymphoma (DLBCL) is a common cancer in haematology. We report a case of DLBCL mimicking malignant pleural mesothelioma (MPM). A 75-year-old man with a 1-week exacerbation of dyspnoea on exertion and right pleural effusion on chest radiography was admitted to our hospital. Positron emission tomography/computed tomography revealed diffuse pleural thick lesions and massive pleural effusion, and these lesions had accumulation of fluorodeoxyglucose. Because we suspected MPM or lung cancer, we performed a biopsy with thoracoscopy to confirm the diagnosis. A biopsy of the pleural effusion with thoracoscopy revealed DLBCL. Chemotherapy was immediately selected, and the diffuse thickened pleural wall and massive pleural effusion of the right chest were significantly improved after two cycles of chemotherapy.

  © 2020 The Author(s).

• Pleural tuberculosis mimicking malignant mesothelioma. W. Dawood, D. La Garza Henriette, G. Iliescu, et al. 2020;29:100964. Case report PubMed · Publisher · Free full text

2010s

• A 75 year old male with recurrent unilateral pleural effusion and positive ANA. T. Wallen, N. Jagan, M. Krishnan, et al. 2019;26:301-303. Case report PubMed · Publisher · Free full text

  Abstract

  This case report describes the clinical course and diagnostic challenges arising in a 75 year old man who initially presented with progressive shortness of breath. Imaging revealed a pleural effusion, which was recurrent following thoracentesis. While his initial workup suggested an autoimmune etiology, further diagnostic testing revealed a diagnosis of malignant pleural mesothelioma. Curiously, the patient had no known asbestos exposure, which is classically associated with acquired mesothelioma. There are a small number of similar cases with a possible overlap between positive autoimmune serologies and mesothelioma; however, the underlying pathophysiology remains elusive. It is the authors' goal to contribute this case to the few cases describing such overlap syndromes.

• Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal mesothelioma - A rare clinical presentation. M. Haygarth, K.K. Zaw, V. Yachmenikova, et al. 2019;26:326-327. Case report PubMed · Publisher · Free full text

  Abstract

  Diffuse pulmonary metastasis secondary to primary peritoneal malignant mesothelioma is rarely reported in the literature. In this report we describe a 59-year-old Caucasian women with no known previous asbestos exposure presenting with bilateral diffuse pulmonary opacities in association with primary malignant peritoneal mesothelioma. The diagnosis was confirmed by ultrasound guided abdominal and bronchoscopy, trans-bronchial lung biopsy. The biopsy demonstrated positive staining with AE1/3, CK7, CK5/6, WT1, calretinin and D2 40. The cells were negative for BerEP4, PAX8, CA125, ER, CD34, ERG, P63, P40, Melan A, Gata3 and mammaglobin. The morphology and immunohistochemical profile supported a diagnosis of epithelioid malignant mesothelioma.

• Case report: Steroid responsive mesothelioma-related pleural effusion. M. Shehata, F. Zaid, P. Ottaviano, et al. 2019;26:131-135. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is an asbestos-related tumor arising in the pleural cavity. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. The most common radiologic presentation is ipsilateral pleural effusion with or without pleural thickening or a mass. Thoracoscopic biopsy remains the most appropriate procedure for definitive diagnosis of mesothelioma. Despite advancement in diagnostic procedures and biomolecular research, this tumor nevertheless has poor prognosis. Mesothelioma remains a diagnostic and therapeutic challenge and is likely to remain one in the years to come. Here we present the first reported case of steroid treatment responsive pleural effusion in a 72 year-old-male that initially was misdiagnosed as rheumatoid related effusion. However, Pleuroscopy with biopsy revealed mesothelioma.

• Simultaneous presence of lung adenocarcinoma and malignant pleural mesothelioma: A case report. M. Yamazoe, H. Tomioka, T. Kamada, et al. 2019;26:45-49. Case report PubMed · Publisher · Free full text

  Abstract

  The co-presence of malignant pleural mesothelioma (MPM) and lung cancer is rare. We report a 70-year-old male with exposure to asbestos. Chest computed tomography revealed a right mediastinal mass combined with an enlarged ipsilateral lymph node and left pleural effusion. Transbronchial lung biopsy revealed lung adenocarcinoma. Thoracoscopic examination revealed multiple left pleural nodules, leading to the diagnosis of MPM. Despite aggressive anticancer drug therapy, he expired due to disease progression 2.5 years after diagnosis. Autopsy confirmed an epithelioid MPM in the left pleura. MPM comorbidity in patients diagnosed with lung cancer should be considered, especially in those exposed to asbestos.

• Successful treatment of late onset empyema after extrapleural pneumonectomy: A case report. S. Nishikawa, S. Tamari, K. Okita, et al. 2019;26:174-175. Case report PubMed · Publisher · Free full text

  Abstract

  Treatment of post-extrapleural pneumonectomy empyema (PEPPE) is more difficult than that for post-pneumonectomy empyema for two reasons: first, a large infectious dead space remains after extrapleural pneumonectomy (EPP); and second, defects of the pericardium and diaphragm are reconstructed with artificial materials, which ideally should be removed for treatment of infection. Here, we report the case of a 56-year-old male with PEPPE that occurred long after EPP for mesothelioma. The patient was treated successfully by minimally invasive procedures of irrigation, instillation of urokinase and antibiotics, and surgical debridement without peeling off artificial materials.

• Sudden cardiac death due to primary malignant pericardial mesothelioma: Brief report and literature review. R. Martínez-Girón, L. Pantanowitz, S. Martínez-Torre, et al. 2019;26:185-188. Case report PubMed · Publisher · Free full text

  Abstract

  Sudden cardiac death is an unexpected clinical condition that typically occurs due to a cardiac cause, generally within 1 h of symptom onset, in people with known or unknown cardiac disease. Primary malignant pericardial mesothelioma, as a cause of sudden death, is an uncommon consequence of a rare disease. Herein, we present a case of cardiac tamponade due to a primary pericardial mesothelioma. Cytological, histopathology and gross post-mortem findings, in a previously asymptomatic 46-old-year man, are reported. The medical literature regarding this topic is also reviewed.

• An unusual case of chylothorax. L.A. Benninger, J.A. Ross, M.E. Leon, et al. 2018;25:318-322. Case report PubMed · Publisher · Free full text

  Abstract

  Pleural effusions occur in up to 70% of cases of malignant pleural mesothelioma (MPM). However, MPM rarely presents as a chylous effusion making it a diagnostic challenge. There are only six reported cases to date. Most cases of chylothoraces due to malignancy are due to lymphoma or bronchogenic carcinoma. We report an interesting case of MPM in a 75-year-old man who presented with recurrent chylothorax. He reported a four-month history of dyspnea and chest discomfort. Chest x-ray revealed a pleural effusion. Pleural fluid analysis was consistent with a chylothorax. Pleural fluid cytology was negative for malignancy. Computed tomography of the chest showed pleural calcifications, mediastinal adenopathy and left lung infiltrate. A fine needle aspirate of the lymph node and transbronchial biopsy specimen (TBBX) of the left lung infiltrate showed extensive reactive appearing mesothelial cells but none that appeared malignant. A video assisted thoracoscopic surgery was suggested but the patient declined. He returned 3 months later with recurrent pleural effusion and worsening airspace disease. Thoracentesis revealed a chylothorax again. Repeat analysis of TBBX and lymph node specimens showed extensive reactive appearing mesothelial cells. Due to concern for MPM, ancillary testing was obtained - loss of BRCA1 associated protein (BAP-1) and CDKN2A/p16 gene deletion. BAP1 staining was lost in the mesothelial cells supporting MPM. This case highlights a rare cause of MPM presenting as a chylous effusion. In a patient with an unknown etiology of chylothorax, MPM must remain in the differential.

• Cavitary lung lesion suspicious for malignancy reveals Mycobacterium xenopi. S. Fogla, V.M. Pansare, L.G. Camero, et al. 2018;23:83-85. Case report PubMed · Publisher · Free full text

  Abstract

  We report the case of a 68-year-old gentleman who presented with musculoskeletal chest pain which appeared suddenly when he bent over with his dog. The chest pain was localized to the left lower chest and increased with movement and deep breathing. The patient did not complain weight loss, night sweat, fever or chill. He complained of mild cough, with expectoration of whitish mucus. Imaging revealed cavitary chest lesion in the right upper lobe, which was initially suspected to be lung cancer. The patient had a 50-year-old history of smoking 2 packs per day. PET CT imaging did not reveal any specific activity. Needle biopsy and bronchoalveolar lavage, however, did not reveal any malignant cells. Rather, necrotic tissues were observed. A wedge resection of the lung mass was performed. No common organisms or fungi could be grown. However, acid fast bacilli were observed in clumps. The morphology hinted towards non-tuberculous mycobacterial organism(s). Molecular studies revealed infection with Mycobacterium xenopi. The patient was started on an anti-tuberculous regimen of INH, rifampicin, ethambutol and PZA, with pyridoxine. The patient is a Vietnam veteran and complained of exposure to dust from a bird's nest and asbestos exposure in childhood, but no specific exposure to tuberculosis. The patient had an uneventful recovery post-surgery. He complained of some nausea after initiation of the antituberculous medications, but his pain subsided with time. The patient had diabetes, though specific reasons of compromise of immune status could not be pinpointed as causative of his nontuberculous mycobacterial lung infection.

• Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion. U. Durani, A. Gallo de Moraes, J. Beachey, et al. 2018;24:77-80. Case report PubMed · Publisher · Free full text

  Abstract

  Angiosarcomas are rare cancers accounting for less than 2% of all soft tissue sarcomas. We report the case of an unusual presentation of pleural epithelioid angiosarcoma in a patient with constrictive pericarditis and recurrent pleural effusion. A 62 year old smoker presented with acute chest pain. ECG showed diffuse elevation of ST segments in the precordial leads. After extensive evaluation, he was diagnosed with viral pericarditis and treated with colchicine. Two weeks later the patient presented to the emergency department with a large right pleural effusion. Evaluation of the pleural fluid obtained from a thoracentesis revealed an exudative effusion with negative microbial studies and no evidence of malignant cells. His pleural effusion re-accumulated rapidly, requiring repeated thoracenteses over several weeks. Medical thoracoscopy was performed and pleural biopsy revealed primary pleural epithelioid angiosarcoma. Staging PET scan revealed malignant enhancement of right pleura, pericardium, right iliac bone and right shoulder. He died suddenly within 6 weeks of diagnosis, prior to initiating palliative chemotherapy. Pleural angiosarcoma should be considered in the differential diagnosis of recurrent pleural effusions of unknown etiology. Negative cytology does not rule out the diagnosis; excisional biopsy is required. Reported risk factors include asbestos exposure, prior chest radiation, active smoking and history of complicated pleural tuberculosis. Pleural epithelioid angiosarcomas carry a very poor prognosis, with the majority of patients dying within months of diagnosis.

• Malignant mesothelioma presenting as recurrent hydro-pneumothorax: An atypical case presentation and literature review. N. Sattar, R. Durrance, A. Khan, et al. 2018;23:152-155. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant Pleural Mesothelioma (MPM) is a rare pleural malignancy, with a vague presentation complicated by a decades-long latency period between environmental exposure and clinical manifestations. Spontaneous hydro-pneumothorax is a rare presentation of MPM, most often requiring invasive tissue biopsy to confirm the etiologic diagnosis. We present the case of 79-year-old male smoker with no documented history of asbestos exposure, who was found to have MPM after presenting with dyspnea and subsequently found to have recurrent hydro-pneumothorax. On Literature review of the limited documented cases of MPM with hydro-pneumothorax, we found an exclusively male population with a significant smoking history, a marked right sided pathology predominance, and a generally poor prognosis. While this corresponds with the examined case, and suggests that the presence of hydro-pneumothorax implies a high-grade tumor and significant tissue invasion, and therefore poor prognosis similar to that of stage 4 disease, it differs from more generalized case reviews of MPM, most importantly in their anatomical descriptions, prognostic indicators, and epidemiologic tendencies.

• Pleural amyloidosis imitating pleural malignancy. F. Coolbear, A.M. Bilawich, J. Tongson, et al. 2017;20:195-197. Case report PubMed · Publisher · Free full text

  Abstract

  CT chest performed to investigate dyspnea and malaise in an 83 year old man demonstrated bilateral circumferential pleural thickening highly suspicious for pleural mesothelioma or metastatic pleural malignancy. Histopathology of a subsequent pleural biopsy returned a diagnosis of pleural amyloid. This case identifies pleural amyloid as a rare differential consideration for diffuse pleural thickening; the difficulties in distinguishing pleural amyloid from pleural malignancy are highlighted.

• Tuberculous pleural effusion occurring concurrently with asbestos-related pleural disease. M. Zantah, D. Datta. 2017;21:135-137. Case report PubMed · Publisher · Free full text

  Abstract

  An eighty-four-year-old man presented with progressive exertional dyspnea, productive cough and weight loss for two months. His physical exam was notable for diminished breath sounds at the right base, with dullness to percussion. Chest-x-ray showed moderate right-sided pleural effusion and bilateral calcified pleural plaques as well as diaphragmatic plaques consistent with asbestos-related pleural disease (ARPD). Pleural fluid was exudative with predominantly mononuclear cells, negative acid fast bacilli stain, negative cultures, and negative cytology for malignant cells. Due to recurrence of the effusion, 4 weeks after drainage, thoracoscopic pleural biopsy was planned but pleural fluid cultures came back positive for mycobacteria tuberculosis. Patient was started on anti-tubercular therapy but treatment had to be stopped due to liver toxicity. Patient subsequently developed pneumonia and deteriorated despite antibiotic therapy and expired.

• Malignant pleural mesothelioma in a 17-year old boy: A case report and literature review. C. Pérez-Guzmán, R. Barrera-Rodríguez, J. Portilla-Segura. 2016;17:57-60. Case report PubMed · Publisher · Free full text

  Abstract

  Background: Malignant pleural mesothelioma is a rare, invasive and often fatal neoplasm that develops in the thin layer of tissue surrounding the lungs known as the pleura. Although rare, mesotheliomas do occur in the young; their characteristics are distinct from those of older patients.

  Case Presentation: This is a case report of a 17-year-old boy who had moderate dyspnea, cough, right-sided pleuritic chest pain, fever, headache and no weight loss. Physical examination showed a right pleural effusion and chest roentgenograms revealed a homogenous opacity on lower right hemithorax. Biochemical analysis of pleural fluid showed hemorrhagic/turbid effusion compatible with exudate. It was initially treated as an empyema. The pleural fluid culture was negative. Adenosine deaminase level was 34.3 U/L (admission) and 19.02 U/L (two weeks after). Pleural fluid smear and culture for Mtb were negative. During the open pleural biopsy, thickened pleura and multiple pale yellow nodules in the lung were observed. The histopathological report was compatible with malignant pleural mesothelioma. With this diagnosis, a chemotherapy regimen with cisplatin was initiated. After two cycles, the patient had no clinical and radiological improvement. The patient is currently under regular follow up.

  Conclusion: MPM is rare in young adults and its clinical presentation makes it different from mesothelioma in elderly patients, so it will be necessary to identify the new risk factors that can identify these patients.

• Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma. D. DeLapp, C. Chan, P. Nystrom. 2016;19:43-5. Case report PubMed · Publisher · Free full text

  Abstract

  Mesothelioma is a rare pulmonary malignancy commonly associated with asbestos exposure. Its presentation is insidious and non-specific, with complaints of chest pain, dyspnea and cough. Chest X-ray may demonstrate unilateral pleural effusion. CT and PET scans may highlight nodular pleural plaques. Diagnosis often times is difficult with negative imaging and negative pleural fluid studies. In rare cases, hydropneumothoraces may be seen. We report a case of malignant pleural mesothelioma presenting as recurrent hydropneumothorax with negative CT scan of the chest for pleural abnormalities and negative pleural fluid studies.

• A rare clinical case - Solitary fibrous tumor of the pleura. A. Papadopoulos, I. Porfyridis, G. Christodoulides, et al. 2015;16:117-9. Case report PubMed · Publisher · Free full text

  Abstract

  We present a case of a 58 years old man with a large heterogeneous and well circumscribed soft tissue mass arising from the right pleural surface, found at a computer tomography of his chest. This mass after complete resection through a right lateral open thoracotomy, proved to be a Solitary Fibrous Tumor, previously known as 'benign mesothelioma'. This tumor is usually discovered at routine chest X-rays since patients are either asymptomatic or report atypical symptoms. Only 10-20% of the published cases report a malignant solitary fibrous tumor, however, definite diagnosis can only be made after complete resection which is the proposed diagnostic algorithm for these cases.

• Fatal pulmonary hemorrhage after taking anticoagulation medication. S.P. Hammar. 2015;15:66-70. Case report PubMed · Publisher · Free full text

  Abstract

  We describe a 64-year-old man with extensive diffuse acute lung hemorrhage, presumably as a result of anticoagulation therapy. We evaluated reports in the literature concerning acute exacerbation (acute lung injury of unknown cause) in UIP and other forms of fibrotic interstitial pneumonias. We also evaluated autopsy tissue in this case in order to determine the cause of death in this 64-year-old man, who was initially thought to have an asbestos-related disease. Based on the autopsy findings, this man died as a result of anticoagulation therapy; specifically, the use of Xarelto(®) (rivaroxaban).

• Foreign body granuloma mimicking recurrence of malignant pleural mesothelioma. T. Nakasuka, N. Fujimoto, N. Hara, et al. 2015;16:95-6. Case report PubMed · Publisher · Free full text

  Abstract

  A 72-year-old man visited our hospital due to right pleural effusion. He had worked as a welder at a shipbuilding company and had been exposed to asbestos. Cytological examination and thoracoscopic pleural biopsy yielded a diagnosis of epithelial malignant pleural mesothelioma (MPM); extrapleural pneumonectomy (EPP) was performed. Two years later, he became aware of right-back swelling that became a fist-sized mass over 2 months. Microscopy of a tissue specimen revealed no malignant cells, but did indicate foreign body granuloma. Subcutaneous lesions that develop after EPP do not necessarily result from the recurrence of MPM, but could have benign etiologies.

• Lymphoproliferative disorder in pleural effusion in a subject with past asbestos exposure. N. Hara, N. Fujimoto, Y. Miyamoto, et al. 2015;16:169-71. Case report PubMed · Publisher · Free full text

  Abstract

  Primary effusion lymphoma (PEL) is a subtype of non-Hodgkin lymphoma that presents as serous effusions without detectable masses or organomegaly. Here we report a case of PEL-like lymphoma in a patient with past asbestos exposure. A 65-year-old man was referred to our hospital due to dyspnea upon exertion. He had been exposed to asbestos for three years in the construction industry. Chest X-ray and CT images demonstrated left pleural effusion. Cytological analysis of the pleural effusion revealed large atypical lymphocytes with distinct nuclear bodies and high nucleus-to-cytoplasm ratio. Immunohistochemical analyses showed that the cells were CD20(+), CD3(-), CD5(-), and CD10(-). These findings led to a diagnosis of diffuse large B-cell lymphoma. PEL or PEL-like lymphoma should be considered a potential cause of pleural effusion in subjects with past asbestos exposure.

• An unusual cause of an anterior mediastinal mass. I. Hassan, A. Goolam-Mahomed. 2014;12:52-4. PubMed · Publisher · Free full text

  Abstract

  Mesothelioma is a rare tumour and its radiological growth pattern varies. We report the case of a biopsy proven Malignant Pleural Mesothelioma (MPM) presenting as an anterior mediastinal mass in a platinum miner. The prognosis for this aggressive tumour remains poor, despite combination treatment modalities.

• Multiple distant metastases in a case of malignant pleural mesothelioma. K.C. Tertemiz, A. Ozgen Alpaydin, D. Gurel, et al. 2014;13:16-8. PubMed · Publisher · Free full text

  Abstract

  Introduction: Malignant pleural mesothelioma (MPM) is a malignant of mesodermal neoplasm and arises from multipotential mesothelial or subserosal cells of the pleura, pericardium and peritoneum.

  Case: A seventy five year-old male patient was admitted with chest and lower limb pain. He was a heavy smoker and exposed to environmental asbestos in his childhood. PET-CT scans showed multiple pathological FDG uptakes in lungs and other organs. Biopsies performed from lung and anterior thigh muscles were reported as epitheloid type malignant pleural mesothelioma.

  Discussion: We emphasize that unexpected distant metastases can be observed in MPM and occasionally primary diagnosis can be determined by the biopsy of the metastatic regions. This case also points out the role of PET-CT in the staging of malign mesothelioma by determining different metastatic sites.

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