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Xanthomatous pleuritis mimicking mesothelioma
Franklin R McGuire1, Todd Gourdin, James L Finley
1University of South Carolina School of Medicine, Columbia, SC 29203, USA. fmcguire@gw.mp.sc.edu
Respiration; International Review of Thoracic Diseases
|January 29, 2008
Summary
Xanthomatous pleuritis can mimic mesothelioma, posing a diagnostic challenge. Medical thoracoscopy aids diagnosis, and prompt steroid therapy led to recovery in this perplexing pleural effusion case.
Area of Science:
- Pulmonology
- Pathology
- Thoracic Surgery
Background:
- Recurrent non-malignant exudative pleural effusions present diagnostic challenges.
- Fluid analysis often fails to provide a definitive diagnosis.
- Medical thoracoscopy offers direct pleural visualization and biopsy under sedation.
Observation:
- A 69-year-old female presented with a large left pleural effusion.
- Initial thoracoscopy revealed plaques, and histology suggested mesothelioma.
- Discordant pathology necessitated repeat thoracoscopy and extensive immunohistochemistry.
Findings:
- The final diagnosis was xanthomatous pleuritis, not mesothelioma.
- Xanthomatous pleuritis can present with misleading macroscopic and histologic features.
- The patient recovered well with steroid therapy.
Implications:
- This case highlights the utility and complexities of medical thoracoscopy in diagnosing rare pleural conditions.
- Accurate diagnosis is crucial for appropriate management of exudative pleural effusions.
- Xanthomatous pleuritis is a treatable condition with a favorable prognosis after correct diagnosis.
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