Dilemma in Diagnosing Malignant Pleural Mesothelioma with Atypical Clinical Presentation and Imaging Findings : Recurrent Chylothorax, Mediastinal Lymphadenopathies and Pulmonary Embolism

Abstract

Malignant pleural mesothelioma (MPM) is a rare malignant tumor affecting the mesothelium. It commonly manifests as pleural thickening on contrast enhanced CT (CECT) thorax. We reported a case of a young lady who presented with respiratory symptoms and was initially treated as pneumonia. However, she had recurrent episodes of chylotho- rax with progressive internal jugular vein (IJV), brachiocephalic vein and superior vena cava (SVC) thrombosis lead- ing to pulmonary embolism, associated with extensive mediastinal and supracalvicular lymphadenopathies. There are no evidence of pleural thickening in the initial investigations. Our case highlighted that MPM must remain in the differential diagnosis for these presentations, albeit rare.