A case of pleural mesothelioma discovered due to hydropneumothorax, with a challenging diagnosis

Abstract

The patient was a 70-year-old male referred to our department for evaluation and treatment of right hydropneumothorax. After undergoing thoracic drainage, thoracoscopic bullectomy was performed. However, due to severe adhesions, a thoracotomy was conducted, requiring partial resection of the right upper and middle lobes. Pathological specimens indicated interstitial pneumonia and reactive mesothelial hyperplasia, but mesothelioma could not be ruled out. Five months later, PET/CT findings indicated that mesothelioma could not be definitively excluded, leading to a re-evaluation of the pathological findings and a diagnosis of epithelioid mesothelioma. Considering the patient’s advanced age and low pulmonary function, radical resection was deemed unfeasible. Chemotherapy could not continue due to the exacerbation of interstitial pneumonia, but immune checkpoint inhibitors continued. The patient passed away 32 months later.