Malignant pleural mesothelioma mimics thoracic empyema: A case report

Our plain-English summary of Malignant pleural mesothelioma mimics thoracic empyema: A case report, by Y.H. Yao, Y.S. Kuo (World Journal of Clinical Cases, 2023).

The study

• Authors: Y.H. Yao, Y.S. Kuo
• Journal: World Journal of Clinical Cases
• Published: 2023;11(35):8372-8378
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Thoracic empyema and malignant pleural mesothelioma (MPM) are distinct medical conditions with similar symptoms, including cough, chest pain, and breathing difficulty. We present a rare MPM case mimicking thoracic empyema. Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions, indicating thoracic empyema.

Case Summary: A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d, particularly during physical activity. A poor appetite and 4 kg weight loss over the past 3 wk were also reported. Chest images and laboratory data concluded a tentative impression of empyema thoracis (right). Video-assisted thoracic surgery with decortication and delobulation (right) was conducted. The pathological report yielded an MPM diagnosis. Refractory pleural bilateral effusions and respiratory failure developed postoperatively, and the patient died three weeks after the operation.

Conclusion: Thoracic empyema and MPM are distinct medical conditions that can present similar symptoms, and video-assisted thoracic surgery facilitates an accurate diagnosis. Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.

©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.

In plain English

This case report from Tri-Service General Hospital in Taipei, Taiwan, described a 68-year-old retired male construction worker, a non-smoker. He came to the emergency department after 10 days of shortness of breath and chest tightness, with a 4 kg weight loss over the previous 3 weeks. Blood tests showed a high white blood cell count. Chest imaging showed multiple lobulated fluid collections on the right, suggesting thoracic empyema (pus in the chest cavity). No germs grew from the fluid. During video-assisted thoracic surgery, surgeons found bloody fluid and tiny pleural nodules. The biopsy showed epithelioid malignant pleural mesothelioma; later tests placed it at stage IIIB. After surgery, fluid built up on both sides of the chest and he developed respiratory failure. He received one course of cisplatin-based chemotherapy and died on the 21st postoperative day. The article did not describe any asbestos exposure for this patient. The authors concluded that this type of surgery can give an accurate diagnosis, and that an empyema-like presentation and persistent fluid after surgery may signal a poor outcome.

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 68-year-old retired male construction worker, a non-smoker, treated at Tri-Service General Hospital, Taipei, Taiwan, starting January 2023
• Exposure: The article gives no asbestos exposure history for the patient. It reports only his former job as a construction worker and that he was a non-smoker. The abstract urges doctors to consider mesothelioma in patients exposed to building material, without naming a fiber type.
• Main results:
  • At admission the patient's white blood cell count was elevated at 24020/µL, with 92.5% neutrophils.
  • No pathogens grew from the patient's pleural fluid. The Rivalta test was positive, raising suspicion of empyema.
  • Chest X-ray and CT showed multiple lobulated pleural effusions on the right, suggesting thoracic empyema.
  • During video-assisted thoracic surgery, tiny pleural nodules were seen, and frozen sections from the pleural biopsy showed malignancy.
  • The pathology report on the pleural nodules showed poorly differentiated carcinoma compatible with malignant pleural mesothelioma. Immunostaining supported the epithelioid subtype.
  • The final diagnosis was malignant pleural mesothelioma with malignant pleural effusion on both sides, epithelioid subtype, clinical stage T4N0M0, stage IIIB. The stage was determined after further examinations, including blood tests, abdominal CT, brain MRI and a bone scan.
  • Fluid that appeared on the left side after surgery was bloody, and its cytology suggested malignancy.
  • The patient developed acute respiratory failure on the tenth postoperative day.
  • After one course of cisplatin-based chemotherapy, the patient developed pneumonia, severe acute respiratory distress syndrome and septic shock, and died on the 21st postoperative day.
• The authors' conclusion: The authors concluded that video-assisted thoracic surgery can offer an accurate diagnosis, and that empyema-mimicking presentations and postoperative refractory pleural effusion may signal poor outcomes for malignant pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Empyema, Pleural Effusion, Thoracic Surgery, Bilateral.

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