“Massive unilateral - right pleural effusion ”
So far, 4 liters drained from 2 thoracentesis. Another scheduled. Bloody fluid positive for calretinin and wt-1. LDH 612. CT shows pleural thickening, plaques, and lymphadenopathy- axillary nodes 2.2 and 1.7 cm on short axis. Can this be anything other than mesothelioma? PET scheduled with FU bronchoscopy if warranted. PCP stated "never heard of" calretinin or wt-1. Pulmonologist said "no cancer," -assuming meant no adenocarcinoma
Male | 49 years old
Complaint duration: 1 month
Medications: Na
Conditions: Na
1 Answer
A recurrent blood pleural effusion with positive calretinin and negative cytologies for other malignancies in the setting of pleural plaques is most likely mesothelioma. The question, could it be anything else is tricky because in medicine we often find exceptions and few things are absolute. A PET scan and VATs pleural biopsy can confirm the diagnosis. Bronchoscopy could get a biopsy of the lymph nodes, but I am not sure that is necessary with a PET and VATs biopsy
