Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma

Our plain-English summary of Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma, by H.E. Fayed, V.K. Woodcock, J. Grayez (BMJ Case Reports, 2013).

The study

• Authors: H.E. Fayed, V.K. Woodcock, J. Grayez
• Journal: BMJ Case Reports
• Published: 2013;2013
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This is a case of a 69-year-old man with a history of asbestos exposure who presented with acute shortness of breath. His chest x-ray showed bilateral hydropneumothorax. Further investigations including CT chest and video-assisted thoracoscopic surgery revealed bilateral pleural thickening and histology confirmed epithelioid mesothelioma. This case highlights the need for clinicians to be aware of atypical presentations of malignant pleural mesothelioma as well as the importance of considering underlying secondary causes such as malignancy in the older patient presenting with spontaneous pneumo/hydropneumothorax.

In plain English

This case report described a 69-year-old man, a lifelong non-smoker, who was an electrician with a history of asbestos exposure between ages 15 and 30. The article did not give the fiber type. He arrived with six days of breathlessness and fleeting chest pain. A chest x-ray and CT scan showed hydropneumothorax (air and fluid around the lung) on both sides, with lung collapse and pleural thickening, more marked on the left. Fluid tests found no malignant cells, but pleural biopsies taken during keyhole surgery (VATS) showed epithelioid mesothelioma. He had four cycles of cisplatin and pemetrexed chemotherapy and initially responded well. Eleven months after diagnosis, scans showed the disease had progressed, and he died four months later. In a literature search, the authors found one earlier case of mesothelioma first presenting as pneumothorax on both sides, and none with hydropneumothorax on both sides. The authors concluded that clinicians should be aware of unusual presentations of malignant pleural mesothelioma. They also concluded that CT scanning should be considered in older patients with spontaneous pneumothorax or hydropneumothorax, particularly with a history of environmental asbestos exposure.

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
• Who was studied: One previously fit and healthy 69-year-old man, a lifelong non-smoker. The authors were at the Department of Medicine, Oxford University Hospitals, Banbury, UK. No date of presentation was given.
• Exposure: Asbestos exposure between the ages of 15 and 30 years. The patient was an electrician by trade. The fiber type was not stated.
• Main results:
  • In this patient, CT showed large hydropneumothorax on both sides, with significant collapse of the underlying lungs.
  • CT showed pleural thickening on both sides, more marked on the left.
  • Cytology of the pleural fluid showed no malignant cells.
  • Video-assisted thoracoscopic surgery (VATS) showed pleural nodules. Pleural biopsies revealed epithelioid mesothelioma.
  • After four cycles of cisplatin and pemetrexed chemotherapy, the patient responded well both clinically and on follow-up imaging.
  • Eleven months after diagnosis, imaging showed disease progression. The patient died 4 months later.
  • In their literature review, the authors found only one case report of bilateral spontaneous pneumothorax as the first presentation of malignant pleural mesothelioma. They found no cases of bilateral hydropneumothorax in mesothelioma.
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma can present in unusual ways, and that clinicians should be aware of such atypical presentations. They concluded that CT scanning should be considered in older patients presenting with spontaneous hydropneumothorax or pneumothorax to identify possible underlying malignancy, particularly when there is a history of environmental asbestos exposure.

Topics

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

Medical terms in this study, explained in our Lexicon: Bilateral, Pleural Mesothelioma, Asbestos Exposure, Chest X-Ray, Video-Assisted Thoracoscopic Surgery (VATS), Pleural Thickening, Histology, Epithelioid.

Related studies

• Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: a report of 2 cases — H.Z. Saleh, E. Fontaine, et al. (2012)
• Recurrent hydropneumothorax as a presenting feature of malignant mesothelioma — K. Guha, D. Jones, et al. (2008)
• Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma — P. Höllinger, D. Gaeng (1997)
• Lepidic intrapulmonary growth of malignant mesothelioma presenting as recurrent hydropneumothorax — H. Wu, G. Tino, et al. (1996)
• Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion — C.A. Hinkamp, S.N. Dalal, et al. (2020)
• Spontaneous bilateral haemothorax as presentation of primary pleural epithelioid haemangioendothelioma — L. Ferreiro, E. San-José, et al. (2017)

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