Subarachnoid-pleural fistula as a complication of malignant pleural mesothelioma

Our plain-English summary of Subarachnoid-pleural fistula as a complication of malignant pleural mesothelioma, by C.M. Heyer, A. Theile, H. Weisser, et al (Respirology, 2006).

The study

• Authors: C.M. Heyer, A. Theile, H. Weisser, J. Reichert, C. Horch, K.M. Mueller, T.T. Bauer
• Journal: Respirology
• Published: 2006;11(4):502-5
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a 62-year-old male patient with asbestos-related malignant pleural mesothelioma who developed recurrent pleural effusions after surgical resection of paravertebral tumour masses. Pleural effusions were drained on several occasions with the patient suffering severe headaches and vascular dysregulation. Cytological studies of the pleural fluid showed no evidence of inflammatory or malignant cells. The fluid was interpreted as seroma despite its unusual transparency until magnetic resonance imaging was suggestive of a subarachnoid-pleural fistula; its presence was confirmed when beta-trace protein--a specific marker for cerebrospinal fluid--was added to the standard laboratory testing of the pleural effusion. A subarachnoid-pleural fistula has to be included in the differential diagnosis of patients with recurrent pleural effusions after surgical debulkment of malignant pleural mesothelioma. The beta-trace protein may help to establish this diagnosis especially in cases where important therapeutic consequences may need to be drawn.

In plain English

This case report described a 62-year-old man who had worked in a coal mine, had been exposed to asbestos, and had malignant pleural mesothelioma. The article did not name the type of asbestos. The tumour destroyed part of a rib and a vertebra and grew into the spinal canal, pressing on the spinal cord. The patient had three operations, as well as radiation and chemotherapy. After surgery, fluid kept collecting in the chest. It was drained several times, and the patient had severe headaches. Testing of the fluid found no evidence of inflammatory or cancer cells, and the fluid was first taken to be a seroma. Standard tests for spinal fluid gave no diagnostic result. A test for beta-trace protein, a marker of spinal fluid, measured 40.7 mg/L. Results above 10 mg/L indicate spinal fluid, so the fluid was spinal fluid. MRI showed an abnormal channel letting it leak into the chest, called a subarachnoid-pleural fistula. The patient died a few days later. Autopsy confirmed the fistula and a biphasic malignant mesothelioma. The authors concluded that fluid in the chest of such patients should raise suspicion of this kind of fistula.

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 62-year-old man who had worked in a coal mine; no dates given
• Exposure: asbestos exposure (fiber type, source and amount not stated)
• Main results:
  • CT showed a left-sided pleural tumour with destruction of the ninth rib
  • The tumour destroyed the left pedicle of the ninth thoracic vertebra and grew into the spinal canal, compressing the spinal cord
  • The patient was treated with radiation and chemotherapy as well as surgery
  • Testing of the pleural fluid drained after surgery found no evidence of inflammatory or malignant cells, and the fluid was interpreted as seroma
  • Standard tests for cerebrospinal fluid (glucose, Pandy reaction) gave no diagnostic result
  • Beta-trace protein in the pleural fluid was 40.7 mg/L, which confirmed cerebrospinal fluid. Values above 10 mg/L indicate cerebrospinal fluid.
  • MRI confirmed a subarachnoid-pleural fistula
  • The patient died a few days after the diagnosis
  • Autopsy found cerebrospinal fluid in the chest cavity and confirmed the fistula
  • Tissue testing confirmed a biphasic malignant mesothelioma
• The authors' conclusion: The authors concluded that fluid in the pleural space of patients with malignant pleural mesothelioma should raise suspicion of a subarachnoid-pleural fistula, as opposed to a tumour-associated effusion

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, Pleural Effusion, Surgical Resection, Differential Diagnosis.

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