Malignant mesothelioma presenting as recurrent hydro-pneumothorax: An atypical case presentation and literature review

Abstract

Malignant Pleural Mesothelioma (MPM) is a rare pleural malignancy, with a vague presentation complicated by a decades-long latency period between environmental exposure and clinical manifestations. Spontaneous hydro-pneumothorax is a rare presentation of MPM, most often requiring invasive tissue biopsy to confirm the etiologic diagnosis. We present the case of 79-year-old male smoker with no documented history of asbestos exposure, who was found to have MPM after presenting with dyspnea and subsequently found to have recurrent hydro-pneumothorax. On Literature review of the limited documented cases of MPM with hydro-pneumothorax, we found an exclusively male population with a significant smoking history, a marked right sided pathology predominance, and a generally poor prognosis. While this corresponds with the examined case, and suggests that the presence of hydro-pneumothorax implies a high-grade tumor and significant tissue invasion, and therefore poor prognosis similar to that of stage 4 disease, it differs from more generalized case reviews of MPM, most importantly in their anatomical descriptions, prognostic indicators, and epidemiologic tendencies.

A Rare Presentation of Minimally Invasive Mesothelioma as a Large Tension Pneumothorax

“…The prognosis in these cases is uniformly poor at 6 to 17 months. 3,4,18 For mesothelioma in situ, there are no clear recommendations yet on the optimal treatment approach. 19,20 Close follow up and monitoring is recommended at a minimum due to the potential of progression of mesothelioma in situ to invasive mesothelioma.…”

“…Chest imaging generally reveals pleural-based plaques invading the chest wall and/or pleural effusion. [1][2][3][4][5] Rarely malignant mesothelioma has presented with spontaneous pneumothorax. However, these cases were locally advanced with significant pleural and chest wall invasion.…”

“…Development of mesothelioma is associated with asbestos exposure in roofing and ship-building. [1][2][3][4][5] Common presentations of mesothelioma are with pleural-based plaques invading the chest wall and/or pleural effusion on chest imaging. 1,5 The intent of this case report is to describe a rare presentation of mesothelioma, that presented atypically as a large right tension pneumothorax.…”

Sneaky Diagnosis of Pleural Malignant Mesothelioma in Thoracic Surgery: All That Glitters Is Not Gold

“…Mitsui et al [ 33 ], reviewing Japanese literature, reported a total of 16 MPM patients with spontaneous pneumothorax: 81% were male, and concurrent pleural effusion was present in 56% of cases. Recently, Sattar and colleagues [ 34 ] focused exclusively on patients with MPM presenting as hydropneumothorax. In their literature review, nine cases were collected: a right-sided predominance was observed, exclusively related to the male population, mainly with significant tobacco history.…”

Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion

“…While pleural effusions associated with pleural-based masses are common, literature review suggests that hydropneumothorax is exceedingly rare and is predominantly right-sided, making this case of a left-sided hydropneumothorax particularly unique. A pathophysiological explanation for this right-sided predominance is unknown 26–31. One suggested aetiology in these patients is pleural tumour necrosis or necrosis of regional lung metastases leading to failure of the visceral pleura 27 32 33.…”