Malignant pleural mesothelioma: a case report

Our plain-English summary of Malignant pleural mesothelioma: a case report, by S.N. Patel, N.W. Kettner (Journal of Manipulative and Physiological Therapeutics, 2005).

The study

• Authors: S.N. Patel, N.W. Kettner
• Journal: Journal of Manipulative and Physiological Therapeutics
• Published: 2005;28(9):724-9
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The aim of this study was to discuss a case of malignant pleural mesothelioma (MPM) that presented to a chiropractic teaching clinic and review the pathophysiology of diseases associated with asbestos exposure.

Clinical Features: An 86-year-old woman had right-sided back pain at the thoracolumbar junction for 3 months; this pain prevented her from exercising on a daily basis. She was alert and oriented but in obvious distress because of her back pain. Breath sounds were decreased on the right in the posterior and lower lobes, with dull percussion and increased tactile fremitus. A significant collection of pleural effusion was seen on the right side on plain film radiographs. A chest computed tomography with contrast showed a large right-sided pleural effusion with small consolidation at the right lung base suggestive of pleural or pulmonary malignancy and highly suspicious for MPM. Further questioning about asbestos exposure revealed that her husband was a maintenance worker. An extrapleural pneumonectomy was performed, and specimens of parietal and visceral pleura were sent for pathological, which revealed a definitive diagnosis of spindle cell mesothelioma.

Intervention And Outcome: The patient was diagnosed with MPM, and a surgical therapy option was considered because of the aggressive nature of the lesion and her advanced age. An extrapleural pneumonectomy was performed with removal of parietal and visceral pleura, right lower lobe, and right hemidiaphragm.

Conclusion: This is an unusual case of advanced MPM that is most likely from indirect asbestos exposure.

In plain English

This article reports a single patient's case, followed by a general review of asbestos-related diseases. An 86-year-old woman came to the Logan College of Chiropractic clinic with 3 months of right-sided pain where the mid back meets the lower back. Lumbar spine X-rays taken for her pain unexpectedly showed a large collection of fluid around the right lung (pleural effusion). A chest CT scan the next day was described as highly suspicious for malignant pleural mesothelioma. Asked about asbestos exposure, she said her husband was a maintenance worker. For this patient, the article gives no other details of her exposure and names no fiber type. Surgeons removed the pleura, the right lower lobe and the right half of the diaphragm (extrapleural pneumonectomy), and tissue analysis gave a definitive diagnosis of spindle cell mesothelioma. The article does not report how she fared afterward. The authors concluded this was an unusual case of advanced mesothelioma most likely from indirect asbestos exposure. As a single case, it describes what happened to one person, not how often this occurs.

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 with a narrative review of asbestos-related diseases
• Who was studied: one 86-year-old woman seen at the Logan College of Chiropractic Clinic with 3 months of right-sided back pain at the thoracolumbar junction
• Exposure: possible indirect (household) asbestos exposure: her husband was a maintenance worker. No fiber type, product or dose is given for this patient. The general review section discusses chrysotile, crocidolite and amosite, but not in relation to her.
• Main results:
  • Lumbar spine X-rays taken for back pain showed a significant collection of pleural effusion on the right side
  • Chest CT with contrast showed a large right-sided pleural effusion with small consolidation at the right lung base, highly suspicious for malignant pleural mesothelioma
  • The CT images showed no gross pleural thickening or calcification
  • An extrapleural pneumonectomy removed the parietal and visceral pleura, right lower lobe and right hemidiaphragm
  • Tissue analysis gave a definitive diagnosis of spindle cell mesothelioma
• The authors' conclusion: The authors concluded this was an unusual case of advanced malignant pleural mesothelioma most likely from indirect asbestos exposure

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, Consolidation, Extrapleural Pneumonectomy (EPP), Visceral Pleura, Spindle Cell, Mesothelioma.

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