Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma

Our plain-English summary of Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma, by D. DeLapp, C. Chan, P. Nystrom (Respiratory Medicine Case Reports, 2016).

The study

• Authors: D. DeLapp, C. Chan, P. Nystrom
• Journal: Respiratory Medicine Case Reports
• Published: 2016;19:43-5
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: 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.

In plain English

This case report described one patient, a 67-year-old man, whose malignant pleural mesothelioma first appeared as a right hydropneumothorax (air and fluid around the lung). He was a former smoker who had served four years in the Navy about 40 years earlier. The report does not describe an asbestos exposure history for him. At first, about 1.5 L of fluid was drained and pleurodesis was done, but no cancer cells were found. Eight months later he had a large right pleural effusion. CT showed no pleural abnormalities, the fluid again showed no cancer cells, and a PET/CT scan was negative. Within two weeks the effusion and then the hydropneumothorax returned. A thoracoscopy with pleural biopsy found epithelioid mesothelioma of the visceral pleura, staged T2 N2 M0. After major surgery and chemoradiation he did well for about a year, then returned with fluid in the right chest and died a few months later. The authors concluded that pleural biopsy may be needed early when these problems recur in elderly people with a history of asbestos exposure, even when imaging and fluid tests are negative.

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 (single patient)
• Who was studied: One 67-year-old man with hypertension and hyperlipidemia. He was a former cigarette smoker who first presented with two weeks of shortness of breath and productive cough. The authors are based in Dayton, Ohio, USA. The article does not give dates of care.
• Exposure: The case description does not state an asbestos exposure history or any fiber type for this patient. It notes only that he was a former cigarette smoker who served four years in the Navy about 40 years earlier.
• Main results:
  • At first presentation the patient had a right hydropneumothorax. About 1.5 L of exudative pleural fluid was removed, and cytology was negative for malignant cells.
  • Eight months later, chest X-ray and CT showed a large right pleural effusion without pleural abnormalities. A PET/CT scan was negative.
  • Over the next two weeks he returned twice: first with a right pleural effusion on CT, then with a recurrent right hydropneumothorax on chest X-ray.
  • Thoracoscopy and pleural biopsy showed epithelioid mesothelioma involving the visceral pleura, staged T2 N2 M0.
  • He was treated with mediastinoscopy, extrapleural pneumonectomy, right pericardiectomy, and right hemidiaphragm removal and reconstruction, followed by chemoradiation. He did well for about 1 year, then returned with a right hydrothorax and died a few months later.
• The authors' conclusion: The authors concluded that the case shows the importance of early invasive testing when hydropneumothoraces or unilateral pleural effusions recur, despite negative imaging and negative pleural fluid studies. They added that pleural biopsy may be necessary early in the workup for elderly people with a history of asbestos exposure.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Asbestos Exposure, Dyspnea, Chest X-Ray, Pleural Effusion, PET Scan, Pleural Plaques.

Related studies

• Recurrent pneumothorax: an unusual presentation of malignant mesothelioma — S.I. Handa, A.G. Wilkinson (1989)
• 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)
• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma — H.E. Fayed, V.K. Woodcock, et al. (2013)
• Malignant mesothelioma presenting as recurrent hydro-pneumothorax: An atypical case presentation and literature review — N. Sattar, R. Durrance, et al. (2018)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)

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