Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: a report of 2 cases

Our plain-English summary of Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: a report of 2 cases, by H.Z. Saleh, E. Fontaine, H. Elsayed (Revista Portuguesa de Pneumologia, 2012).

The study

• Authors: H.Z. Saleh, E. Fontaine, H. Elsayed
• Journal: Revista Portuguesa de Pneumologia
• Published: 2012;18(2):93-5
• Type of article: Case report
• Language: Portuguese
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) originates in the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath and have a history of asbestos exposure. It rarely presents as spontaneous pneumothorax. We report here two cases where malignant pleural mesothelioma presented with a spontaneous hydropneumothorax and was only discovered following surgery. We emphasise the need for a chest CT-scan preoperatively in older patients presenting with a secondary pneumo/hydropneumothorax.

Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

In plain English

This case report described two men whose malignant pleural mesothelioma was discovered only after surgery for a spontaneous hydropneumothorax (air and fluid around the lung). The first, a 71-year-old ex-smoker who reported heavy asbestos exposure in the past, had a recurrent right hydropneumothorax after two earlier episodes of right pneumothorax. The second, a 70-year-old current smoker with no history of asbestos exposure, had a right pneumothorax that did not resolve with a chest drain. Neither man had a chest CT scan before surgery. In both men, examination of the removed pleura showed epithelioid mesothelioma. The first man was still alive 16 months later, and the second 12 months after surgery. Of 302 pleurectomies the authors' unit performed for pneumothoraces between 2001 and 2009, only two cases of malignant mesothelioma were identified, a figure the article printed as 0.4%. The authors concluded that spontaneous pneumothorax is a possible presentation of malignant pleural mesothelioma. They wrote that suspicion should increase in older patients with environmental exposure and a hydropneumothorax on chest X-ray, and that a chest CT scan is useful in this setting.

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 of two patients
• Who was studied: Two men, aged 71 and 70, treated by the authors' cardiothoracic unit (Liverpool Heart and Chest Hospital, UK) for right-sided spontaneous pneumothorax or hydropneumothorax
• Exposure: Patient 1 reported heavy asbestos exposure in the past, with no fiber type or job given. Patient 2 had no history of asbestos exposure. Both were smokers: 40 pack-years (ex-smoker) and 45 pack-years (current smoker).
• Main results:
  • Patient 1 (71-year-old man with past heavy asbestos exposure): examination of the resected pleura showed malignant epithelioid mesothelioma
  • Patient 1 was still alive 16 months later
  • Patient 2 (70-year-old man) had no history of asbestos exposure and was a current smoker
  • Patient 2: examination of the pleural specimen revealed an unexpected epithelioid mesothelioma
  • Patient 2 was still alive 12 months after surgery
  • Neither patient had a chest CT scan before surgery
  • In the authors' unit, 302 VATS/open pleurectomies were performed for pneumothoraces between 2001 and 2009, with pleural specimens examined in all cases. Only two cases of malignant mesothelioma were identified, printed as 0.4%.
• The authors' conclusion: The authors concluded that spontaneous pneumothorax is a possible presentation of malignant pleural mesothelioma. They wrote that suspicion should increase in older patients with environmental exposure and with a hydropneumothorax on chest X-ray, and that a chest CT scan is useful in this setting.
• Limitations the authors state:
  • The authors acknowledged that a preoperative chest CT scan, which neither patient had, would probably have changed management plans

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, Mesothelial Cells, Asbestos Exposure, Pneumothorax.

Related studies

• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma — H.E. Fayed, V.K. Woodcock, et al. (2013)
• Lepidic intrapulmonary growth of malignant mesothelioma presenting as recurrent hydropneumothorax — H. Wu, G. Tino, et al. (1996)
• Recurrent hydropneumothorax as a presenting feature of malignant mesothelioma — K. Guha, D. Jones, et al. (2008)
• Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion — C.A. Hinkamp, S.N. Dalal, et al. (2020)
• Malignant Pleural Mesothelioma (MPM) Presenting as Hydropneumothorax — M. Kuramochi, T. Muraoka, et al. (2023)
• Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review — S. Alkhuja, A. Miller, et al. (2000)

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