Malignant pleural mesothelioma presenting as a bilateral pneumothorax

Abstract

We report the case of a 44-year-old woman with a history of asbestos exposure who presented with bilateral pneumothorax. Computed tomography revealed no bulla, but partial pleural thickening of the apex on both sides of the lung and nodules on both sides of the diaphragm. The patient underwent an operation, which showed pleural nodules on the visceral and parietal pleura of both sides. We found a pinhole with air leakage on the upper lobe of the right lung, which was surrounded by small white nodules. There was no air leakage on the left side. Pleural biopsies revealed epithelioid mesothelioma. Further investigations by FDG PET-CT showed uptake in the right hilar and mediastinal lymph nodes. We considered that both sides occurred synchronously (IMIG stage right: stage III, left: stage Ib), or the primary tumor was initially on the right side and spread to the left side by lymphatic or hematogenous metastasis (IMIG stage IV). Chemotherapy is now being performed.