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Richard L. Kradin, M.D.
Dr. Richard Kradin is an Associate Pathologist at Massachusetts General Hospital in the Immunopathology Unit where he performs tissue culture and immunocytochemistry.

Stephen M. Levin, M.D.
Dr. Stephen M. Levin is currently an Associate Professor at the Mount Sinai School of Medicine with clinical interests in mesothelioma and asbestos-related diseases.

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A Case Report: Malignant Mesothelioma with Unexpected Contralateral Mediastinal Shift

Case Introduction: An unusual clinical feature of mesothelioma is the presentation of contralateral mediastinal shift due to pleural mesothelioma tissue, rather than a pleural effusion.

Case Summary: A woman, 63 years of age, who had been treated in the past for invasive ductal carcinoma of the breast, presented with chest pain and breathlessness. A radiograph of the chest revealed that she had contralateral mediastinal shift. Her symptoms were relieved after drainage of over 3 litres of pleural fluid.

Further investigations that she underwent revealed pleural mesothelioma rather than metastatic breast cancer which was expected. A few months later she again re-presented with breathlessness and a contralateral mediastinal shift was also again demonstrated in a chest radiograph.

On this occasion, a thoracic ultrasound revealed only a small loculated pleural effusion and, surprisingly, a large amount of malignant tissue which explained what was appearing in the chest radiographs.

Case Conclusion: This case illustrates that the mesothelioma tissue itself caused the mediastinal shift away from the affected side, not a pleural effusion which usually causes contralateral mediastinal shift in mesothelioma cases.

Author: James S Myerson, Mary ER O'Brien and Shibani Nicum
Credits/Source: Journal of Medical Case Reports 2008, 2:125

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