Abstract
A 45 year old man with malignant pleural mesothelioma had symptoms of prolonged cough, heamoptysis, breathlessness, weight loss and low grade persistent fever. The high prevalence of pulmonary tuberculosis in this environment, coupled with paucity of radiologists in rural areas to competently review his chest radiograph, resulted in making the wrong diagnosis of pulmonary tuberculosis (PTB) as against malignant pleural mesothelioma. He was also wrongly treated for PTB for a period of nine months before referral to a Teaching Hospital. The correct diagnosis was made in a university teaching hospital where adequate specialized manpower was available. Distant metastasis to the liver was already observed at presentation. He was treated with six courses of chemotherapy (Peclitaxel and Cisplastin) and he did well before he was lost to follow-up. Key words: Malignant pleural mesothelioma, PTB, liver metastasis.
Highlights
Mesothelioma is a rare form of cancer that develops from transformed cells originating in the mesothelium, the protective lining that covers many of the internal organs of the body
A case of malignant Pleural Mesothelioma with liver metastasis wrongly managed for pulmonary tuberculosis has been presented
The case history, radiological findings, treatment options and literature have been reviewed. It emphasizes the role of imaging and high index of suspicion in the management of patients with malignant pleural mesothelioma
Summary
Mesothelioma (or, more precisely malignant mesothelioma) is a rare form of cancer that develops from transformed cells originating in the mesothelium, the protective lining that covers many of the internal organs of the body. Following a nine month course of the anti-TB, deterioration of the clinical state of the patient as well as worsening of the radiological features on chest x-ray was noted He was not a known hypertensive or diabetic patient. Computed tomographic scan (Figure 2 to 4) revealed a pleural base lobulated isodense mass (HU = 40) making an obtuse angle with the chest wall It extended to the adjacent lung parenchyma and hilum, encircling and narrowing the right main bronchus. CT-guided biopsy of the mass lesion confirmed the diagnosis He had six courses of chemotherapy at three weeks interval (Peclitaxel and Cisplastin) with marked clinical improvement, evidenced by cessation/reduced frequency of cough and heamoptysis coupled, with significant weight gain. Follow-up radiological assessment was not possible due to the aforementioned reason
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