Chest pain and recurrent chylothorax: an unusual presentation of malignant pleural mesothelioma

Our plain-English summary of Chest pain and recurrent chylothorax: an unusual presentation of malignant pleural mesothelioma, by D.R. Darley, E. Granger, A.R. Glanville (Respirology Case Reports, 2017).

The study

• Authors: D.R. Darley, E. Granger, A.R. Glanville
• Journal: Respirology Case Reports
• Published: 2017;5(5):e00250
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma presenting with recurrent chylous effusion is rare. We describe the case of a 34-year-old female Macedonian immigrant who presented with central chest pain and subsequently a left-sided chylous pleural effusion. The diagnosis was made on pleural biopsy via video-assisted thoracoscopic surgery (VATS). Our case demonstrates the utility of thoracic magnetic resonance imaging (MRI) and the difficulties associated with pleural cytology and cervical lymph node biopsy in the establishment of a diagnosis of mesothelioma. It is a reminder that mesothelioma can metastasize to mediastinal and cervical lymph nodes, can occur in young people, and may present as a chylothorax.

In plain English

This article was a case report about one patient, a 34-year-old woman who was born in Macedonia, moved to Australia at age 20 and had never smoked. She first sought care for central chest pain, followed by a large left-sided pleural effusion of milky fluid called chyle (a chylothorax). Her first CT scan showed no pleural thickening, mass or nodules. Over the next year she needed three more drainages. Scans showed an abnormal lymphatic structure in the neck and upper chest, at first thought to be a congenital malformation. Neck lymph node biopsies showed benign, then atypical reactive, mesothelial cells, which did not give a diagnosis. Eighteen months after she first presented, a pleural biopsy showed invasive epithelioid malignant mesothelioma. The authors thought her disease was most likely linked to domestic rather than occupational asbestos exposure. They cited an earlier study, not this one, that found chrysotile and tremolite in whitewash stones in central Macedonia, Northern Greece. The authors concluded that malignant pleural mesothelioma should be considered when diagnosing chylothorax, and that it can occur in young people.

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 (one patient)
• Who was studied: One 34-year-old woman, born in Macedonia, who emigrated to Australia at age 20 and was a lifelong non-smoker
• Exposure: No measured exposure was reported. The authors judged that her disease was most likely related to domestic rather than occupational asbestos exposure in Macedonia, where she had visited relatives in white-washed buildings. They cited an earlier study (reference 10) reporting chrysotile and tremolite fibres in white-wash stones in central Macedonia, Northern Greece.
• Main results:
  • At first presentation, the chest CT scan showed normal lungs and no pleural thickening, mass or nodules.
  • Over the following year she returned three more times for drainage of left-sided chylous effusions.
  • MRI of the neck and mediastinum showed a complex multi-lobulated structure, initially thought to be a congenital lymphatic malformation. The authors later considered it likely to represent metastatic disease.
  • An excisional biopsy of a neck (left supraclavicular) lymph node showed atypical reactive mesothelial cells. The authors said this was not diagnostic for mesothelioma.
  • Eighteen months after first presentation, a pleural biopsy taken by video-assisted thoracoscopic surgery showed invasive epithelioid malignant mesothelioma.
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma should be considered when doctors are working out the cause of a chylothorax. Because the time to disease in this patient was unusually short, they said it is a reminder that mesothelioma can occur in young people.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Pleural Effusion, Pleural Biopsy, Video-Assisted Thoracoscopic Surgery (VATS), Cytology, Biopsy, Metastasis.

Related studies

• Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma — D. DeLapp, C. Chan, et al. (2016)
• Recurrent pneumothorax: an unusual presentation of malignant mesothelioma — S.I. Handa, A.G. Wilkinson (1989)
• An unusual case of chylothorax — L.A. Benninger, J.A. Ross, et al. (2018)
• Clinical presentation of asbestosis with intractable pleural pain in the adult child of a taconite miner and radiographic demonstration of the probable pathology causing the pain — M.R. Harbut, C. Endress, et al. (2009)
• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)
• Chest pain and ST elevation: not always ST-segment-elevation myocardial infarction — S.A. Pyxaras, G. Lardieri, et al. (2010)

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