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Unusual case of malignant pleural mesothelioma
  1. Timothy Johanan Rajaratnam1 and
  2. Jurgen Herre2
  1. 1West Hertfordshire Hospitals NHS Trust, Watford, UK
  2. 2Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  1. Correspondence to Dr Timothy Johanan Rajaratnam; t.rajaratnam1{at}


We present the case of a 65-year-old woman who presented with progressive dysphagia and was diagnosed with achalasia. She subsequently developed bilateral chylous pleural effusions, with no cause identified despite extensive investigations (including computed tomography (CT) scans, gastroscopy and medical thoracoscopy (MT)) and review at a dedicated pleural multidisciplinary team meeting.

Despite optimal supportive management she deteriorated and was admitted to the intensive care unit, where she passed away due to sepsis and respiratory failure 10 months after initial presentation. A postmortem returned a diagnosis of epithelioid mesothelioma, encasing the carina, distal oesophagus and coeliac axis.

Mesothelioma only very rarely presents with either chylous effusions or achalasia. Additionally while MT normally conveys excellent sensitivity for pleural malignancy, it was insufficient here. This case highlights how an unusually located mesothelioma can produce an unusual clinical picture. It also suggests a role for early video-assisted thoracoscopy to aid diagnosis.

  • respiratory medicine
  • cancer intervention
  • oncology
  • gastroenterology

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  • Contributors Both TJR and JH contributed to the writing of this article. TJR reviewed all medical notes and investigations relating to the case, researched the relevant clinical guidelines and background information, and composed the first draft of the manuscript. JH was one of the lead clinicians involved in the care of this patient, planned the overall format of the manuscript and extensively edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.