Recurrent pneumothorax: an unusual presentation of malignant mesothelioma

Our plain-English summary of Recurrent pneumothorax: an unusual presentation of malignant mesothelioma, by S.I. Handa, A.G. Wilkinson (Scottish Medical Journal, 1989).

The study

• Authors: S.I. Handa, A.G. Wilkinson
• Journal: Scottish Medical Journal
• Published: 1989;34(6):566
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is an uncommon condition with about 250 new cases each year in the United Kingdom, most of which present with dyspnoea due to pleural effusion or chest pain. We report a case of malignant mesothelioma which presented as recurrent pneumothorax.

In plain English

This was a case report from the Department of Medicine at Groby Road Hospital in Leicester. It described an 85-year-old man who came to hospital with four weeks of increasing breathlessness. He had worked as a carpenter and shipwright in the Royal Navy for 16 years until 1933, and then in the Naval Dockyard in Portsmouth until retiring in 1963. The report did not describe any specific asbestos exposure. His chest X-ray showed a large left pneumothorax (collapsed lung) and small fluid collections around both lungs. The pneumothorax was drained, but it came back repeatedly over the following weeks, and fluid drawn from his chest showed features suggestive of cancer. At surgery, both layers of the pleura were thickened and calcified. Tissue examination showed undifferentiated malignant mesothelioma. No asbestos bodies were found. He died three weeks later from a left pyothorax (pus in the chest). The authors suggested that malignant mesothelioma be considered when pneumothorax keeps recurring, particularly in patients who may have been exposed to asbestos.

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 85-year-old man seen at the Department of Medicine, Groby Road Hospital, Leicester (UK); date of presentation not stated
• Exposure: Occupational history only: carpenter working as a shipwright in the Royal Navy for 16 years until he developed pulmonary tuberculosis in 1933, then work in the Naval Dockyard in Portsmouth until retirement in 1963. The article does not state that he was exposed to asbestos and gives no fiber type or dose. He also smoked 1.5 ounces of pipe tobacco each week.
• Main results:
  • First chest radiograph: large left pneumothorax, calcification consistent with old tuberculosis, and small bilateral pleural effusions. No pleural calcification was seen at first, but calcification of the dome of the left hemi-diaphragm was noted on later examinations.
  • The left pneumothorax recurred after chest drain treatment: once ten weeks later, then again with a sizeable left pleural effusion two weeks after that, and again after the effusion was drained.
  • Cytology of the pleural fluid showed features suggestive of malignancy.
  • At thoracotomy, both parietal and visceral pleurae were thickened and calcified, and no other cause for the pneumothorax was identified.
  • Histological and electron-microscopic examination showed undifferentiated malignant mesothelioma.
  • No asbestos bodies were demonstrated.
  • The patient died three weeks later from a left pyothorax.
• The authors' conclusion: The authors presented the case as an unusual presentation of malignant mesothelioma. They noted that their literature review found only three cases presenting with recurrent pneumothorax. They suggested that malignant mesothelioma be included in the differential diagnosis of recurrent pneumothorax, particularly in patients who may have been exposed to asbestos.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pneumothorax, Malignant Mesothelioma, Pleural Effusion.

Related studies

• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• Recurrent pneumothorax following abdominal paracentesis — P.J. Stafford (1990)
• Surgically treated pneumothorax. Radiologic and pathologic findings — K.G. Jordan, J.S. Kwong, et al. (1997)
• Pneumothorax and malignant mesothelioma in patients over the age of 40 — J.D. Sheard, W. Taylor, et al. (1991)
• Malignant mesothelioma presenting as recurrent hydro-pneumothorax: An atypical case presentation and literature review — N. Sattar, R. Durrance, et al. (2018)
• Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma — P. Höllinger, D. Gaeng (1997)

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