Malignant mesothelioma with unexpected contralateral mediastinal shift: a case report

Area of Science:

• Oncology
• Pulmonology
• Radiology

Background:

• Pleural mesothelioma can cause contralateral mediastinal shift, a clinical sign typically attributed to large pleural effusions.
• Malignant mesothelioma is a rare cancer arising from the pleura, often associated with asbestos exposure.

Purpose of the Study:

• To present an unusual case of contralateral mediastinal shift caused by pleural mesothelioma tissue, not effusion.
• To emphasize the importance of considering mesothelioma tissue as a cause of mediastinal shift in relevant clinical contexts.

Main Methods:

• Case report of a 63-year-old woman with a history of breast cancer presenting with dyspnea and chest pain.
• Initial chest radiograph showed contralateral mediastinal shift, treated with pleural fluid drainage.
• Subsequent investigations, including thoracic ultrasound, revealed pleural mesothelioma tissue as the cause of shift.

Main Results:

• The patient initially presented with symptoms relieved by drainage of 3 liters of pleural fluid.
• Further investigations revealed pleural mesothelioma, not metastatic breast cancer.
• A subsequent episode of breathlessness showed mediastinal shift attributed to malignant mesothelioma tissue, not effusion.

Conclusions:

• Contralateral mediastinal shift can be caused by the bulk of mesothelioma tissue itself.
• This presentation is unusual, as pleural effusions are the more common cause of mediastinal shift in mesothelioma.
• Radiological and clinical assessment should consider mesothelioma tissue as a potential cause of mediastinal shift.