Peri-procedural cardiac arrest at medical thoracoscopy in a patient with pleural mesothelioma causing resultant heart failure and an intractable pleural effusion

Our plain-English summary of Peri-procedural cardiac arrest at medical thoracoscopy in a patient with pleural mesothelioma causing resultant heart failure and an intractable pleural effusion, by G. Hood, S. Lakey, E. Turnbull, et al (Breathe, 2025).

The study

• Authors: G. Hood, S. Lakey, E. Turnbull, A. Aujayeb
• Journal: Breathe
• Published: 2025;21(4):250175
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Tension hydrothoraces can cause significant morbidity and even mortality. The resultant heart failure caused the development of an intractable effusion and hyponatraemia which led to the patient's death. https://bit.ly/4m6jGjj.

Copyright ©ERS 2025.

In plain English

This case report described one 72-year-old man treated by a hospital trust in Newcastle, UK. He was a never-smoker who had had asbestos exposure throughout his working life as a telephone engineer. Scans showed a large right-sided pleural effusion (fluid around the lung) with nodules on the lining of the chest. A local anaesthetic thoracoscopy was planned. While lying on his side and being sedated with propofol, he suffered a cardiac arrest. His circulation returned after 1 minute of chest compressions with adrenaline, and 3.1 litres of fluid were drained overall. The authors concluded that the massive effusion had impaired blood return to the heart in that position, and they changed their local practice. A later biopsy showed epithelioid mesothelioma. The fluid then changed type (became transudative). The authors suspected newly developed heart failure. His blood sodium fell to 110 mmol/L. The effusion could not be controlled, and he was discharged home with palliative care and died soon after. As a case report, it describes what happened to one patient.

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 72-year-old male never-smoker with progressive breathlessness, seen at Northumbria Health Care NHS Foundation Trust, Newcastle, UK; no dates of care given
• Exposure: Asbestos exposure throughout his working life as a telephone engineer; no fiber type or dose given. The CT showed no calcified pleural plaques or diaphragmatic plaques.
• Main results:
  • During the procedure, in the left lateral position and shortly after the propofol setting was increased, the patient became hypotensive and unresponsive and had a pulseless electrical activity cardiac arrest.
  • Output was restored after 1 minute of chest compressions with adrenaline. 3.1 L of fluid was drained overall, and the patient was stabilised on intensive care.
  • The authors attributed the arrest to the massive pleural effusion impairing venous return to the heart when the patient was placed on his side. They judged local anaesthetic toxicity, a primary cardiac event, tamponade and anaphylaxis unlikely.
  • The authors believed that propofol, even at a low dose, and fasting contributed to the overall hypotension.
  • A CT-guided biopsy showed epithelioid mesothelioma, staged T1 N0 M0.
  • The pleural fluid, initially exudative, later tested as transudative: pleural protein 13 g/L against serum 37 g/L.
  • BNP was just above normal (418 ng/L, normal below 400) and the effusion protein was very low. The authors suggested newly developed heart failure with preserved ejection fraction. The echocardiogram showed normal left ventricular systolic function, impaired right ventricular radial function and moderate tricuspid regurgitation.
  • Serum sodium was 114 mmol/L at the first oncology appointment and later dropped to 110 mmol/L.
  • The effusion could not be controlled. The patient deteriorated, was discharged home with palliative care support and died soon after.
  • After this case, the authors' unit changed practice: very large effusions are to be drained through a small-bore chest drain before patients are placed on their side.
• The authors' conclusion: The authors concluded that a tension hydrothorax caused a peri-procedural cardiac arrest at medical thoracoscopy, an event recognised in the surgical but not the medical literature. They also concluded that the initially exudative effusion turned transudative and could not be treated, and that these rare processes should be described so the pleural community is aware of them.

Topics

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Pleural Mesothelioma, Pleural Effusion.

Related studies

• Occult primary cardiac lymphomas causing unexpected/sudden death or acute heart failure — A. De Martino, F. Del Re, et al. (2020)
• Diffuse pleural thickening following heart failure-related pleural effusions in an asbestos exposed patient — M. Evison, P. Barber (2015)
• Natriuretic peptides in pleural effusions: Beyond a diagnosis of heart failure — J.M. Porcel (2020)
• 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)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Ultrasound-guided medical thoracoscopy in the absence of pleural effusion — G. Marchetti, A. Valsecchi, et al. (2015)

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