Recurrent Hydropneumothorax as an Initial Presentation of Malignant Pleural Mesothelioma: Diagnostic Challenges and the Evolving Role of Pleural Fluid Cytology

Our plain-English summary of Recurrent Hydropneumothorax as an Initial Presentation of Malignant Pleural Mesothelioma: Diagnostic Challenges and the Evolving Role of Pleural Fluid Cytology, by A. Goedseels, E. De Droogh, P. Hollering, et al (Curēus, 2026).

The study

• Authors: A. Goedseels, E. De Droogh, P. Hollering, M. Hertoghs, E. Peys
• Journal: Curēus
• Published: 2026;18(8):e114913
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive pleural malignancy typically associated with asbestos exposure and characterized by a prolonged latency period, often resulting in delayed diagnosis. Although pleural effusion and pleural thickening are common presentations, recurrent hydropneumothorax is an uncommon initial manifestation. Given the broad differential diagnosis of hydropneumothorax, recurrent cases require a thorough clinical and occupational history and appropriate diagnostic evaluation to avoid overlooking an underlying MPM. This case report describes an uncommon initial presentation of MPM and discusses when it is necessary to obtain a tissue sample to confirm the diagnosis.

Copyright © 2026, Goedseels et al.

In plain English

This case report, from authors at Ziekenhuis aan de Stroom in Antwerp, Belgium, described a 72-year-old man who had never smoked and had no known asbestos exposure. He had a month of worsening breathlessness on exertion and mild left-sided chest pain, and was found to have a collapsed left lung with a small amount of fluid (a hydropneumothorax). A chest drain re-expanded the lung, and a CT scan showed no evidence of malignancy or bullae. One week after discharge, the lung had collapsed again. Tests on the drained fluid showed a small cluster of atypical mesothelial cells that had lost a protein called BAP-1. The authors, citing earlier work, described this finding as highly specific for malignant mesothelial disease. Because the sample had few cells and mesothelioma had not been suspected, the team took pleural biopsies by video-assisted thoracoscopic surgery (VATS). The biopsies confirmed epithelioid mesothelioma. A later PET-CT showed no FDG uptake. The authors concluded that malignant pleural mesothelioma should be considered when a spontaneous hydropneumothorax recurs, even without known asbestos exposure or abnormal imaging.

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 (a single patient)
• Who was studied: One 72-year-old man, a never-smoker with no history of lung disease, treated by the authors' hospital (Ziekenhuis aan de Stroom, Antwerp, Belgium); dates of care not given
• Exposure: No known asbestos exposure; the patient was a never-smoker
• Main results:
  • The patient's CT scan, taken after a chest drain re-expanded the collapsed left lung, showed no evidence of malignancy or bullae
  • At an outpatient visit one week after discharge, the patient's left lung had collapsed again
  • The patient's pleural fluid showed eosinophilic inflammation and a small cluster of atypical mesothelial cells with loss of BAP-1 expression
  • Biopsy was pursued because the fluid sample from the patient had few cells and the inflammatory background raised doubts about how representative it was
  • The patient's pleural biopsies showed atypical cells infiltrating the pleura and extending into fatty (adipose) tissue
  • The patient was diagnosed with epithelioid mesothelioma, and the Belgian mesothelioma board confirmed the diagnosis of malignant pleural mesothelioma
  • The patient's later PET-CT scan showed no FDG uptake
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma should be considered in patients with recurrent spontaneous hydropneumothorax, even without known asbestos exposure or imaging signs of pleural disease

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Fluid Cytology, Asbestos Exposure, Latency, Pleural Effusion, Pleural Thickening, Differential Diagnosis, Occupational History.

Related studies

• Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma — D. DeLapp, C. Chan, et al. (2016)
• A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges — L. Fadl, M. Fadl, et al. (2024)
• Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience — P. Loveland, M. Christie, et al. (2018)
• Lepidic intrapulmonary growth of malignant mesothelioma presenting as recurrent hydropneumothorax — H. Wu, G. Tino, et al. (1996)
• Recurrent hydropneumothorax as a presenting feature of malignant mesothelioma — K. Guha, D. Jones, et al. (2008)
• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma — H.E. Fayed, V.K. Woodcock, et al. (2013)

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