Malignant mesothelioma with unexpected contralateral mediastinal shift: a case report

Our plain-English summary of Malignant mesothelioma with unexpected contralateral mediastinal shift: a case report, by J.S. Myerson, S. Nicum, B. Sharma, et al (Journal of Medical Case Reports, 2008).

The study

• Authors: J.S. Myerson, S. Nicum, B. Sharma, M.E. O'Brien
• Journal: Journal of Medical Case Reports
• Published: 2008;2:125
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Contralateral mediastinal shift due to pleural mesothelioma tissue, rather than a pleural effusion, is an unusual clinical feature of mesothelioma.

Case Presentation: A 63-year-old woman with a past history of treated invasive ductal carcinoma of the breast presented with breathlessness and chest pain. Her chest radiograph revealed contralateral mediastinal shift and drainage of over 3 litres of pleural fluid relieved her symptoms. She underwent further investigations which revealed pleural mesothelioma, rather than the expected metastatic breast cancer. When she represented with breathlessness a few months later, a chest radiograph again demonstrated contralateral mediastinal shift. A thoracic ultrasound on this occasion revealed only a small loculated pleural effusion and, unexpectedly, a large volume of malignant tissue, thereby explaining the chest radiograph appearances.

Conclusion: This case illustrates mediastinal shift away from the affected side which was caused by mesothelioma tissue itself, rather than by a pleural effusion which is the more usual cause of contralateral mediastinal shift in mesothelioma.

In plain English

This case report from The Royal Marsden NHS Foundation Trust, UK, described a 63-year-old woman treated in 1992 for invasive ductal carcinoma of the left breast. In November 2006 she developed breathlessness and chest pain. A chest X-ray showed extensive shadowing on the left side of the chest, with the central chest structures (the mediastinum) shifted toward the other side. Draining 3080 mls of blood-stained fluid relieved her breathlessness. A CT scan showed pleural thickening and a soft tissue mass pushing the left atrium of the heart to the right. A biopsy found a new primary malignant mesothelioma, not the expected spread of her breast cancer. When she became more breathless again, an X-ray still showed the shift. However, ultrasound found only a small pocket of fluid (4 by 8 cm), suggesting that much of the shadowing was tumour tissue. Her breathlessness was managed with other treatments, including chemotherapy, and improved. The authors concluded that in this situation repeated drainage attempts would not help symptoms and might cause unnecessary distress. The report did not discuss 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 (single patient)
• Who was studied: One 63-year-old woman with a past history of treated invasive ductal carcinoma of the left breast (1992). She was seen at The Royal Marsden NHS Foundation Trust, UK, and developed symptoms in November 2006.
• Main results:
  • In November 2006 the chest radiograph showed extensive left-sided shadowing with mediastinal shift. Drainage of 3080 mls of blood-stained fluid relieved her breathlessness.
  • CT showed pleurally based thickening occupying much of the left hemithorax. The left atrium was pushed to the right by an abnormal soft tissue mass.
  • A pleural biopsy taken during VATS showed a new primary malignant mesothelioma rather than spread from her breast cancer.
  • When she became more breathless again, the mediastinal shift persisted. Ultrasound showed only a small loculated fluid collection of 4 by 8 cm, suggesting that much of the shadowing was malignant tissue.
  • Her breathlessness was managed with other therapies, including systemic chemotherapy, and improved.
• The authors' conclusion: The authors concluded that the chest radiograph suggested a large pleural effusion, but CT and ultrasound showed this was not the case. In that situation, repeated attempted pleural drainage would not help symptoms and may cause unnecessary distress.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Pleural Effusion, Carcinoma, Chest X-Ray, Ultrasound.

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