Malignant Mesothelioma is an aggressive primary malignant tumor of the pleura, usually caused by prolong asbestos exposure .The prognosis of malignant pleural mesothelioma is very poor and median survival ranges from 8-14 months from diagnosis. There is a long latency period of development of the cancer from asbestos exposure .The absence of an explicit asbestos exposure is another diagnostic problem.

Case Report: A 60 year old male average body  built with BMI 18.6 Kg/m2, farmer by occupation , non smoker ,ex alcoholic presented  with chief complain of right sided chest pain for 2 month, SOB for 1 month, dry cough for 1month, with past h/o  trauma by iron rod to right side of chest. No h/o asbestos exposure. No significant past history and family history. Examination -Vitals are normal. Pallor 1+, grade 2 Clubbing, no lymphadenopathy. Respiratory examination reveals decrease chest movement, stony dull on percussion, grossly diminished breath sound on right hemi thorax with slightly deviated mediastinum to contralateral side. Investigation -Complete blood haemogram normal except leucocytosis. CXR-Right massive pleural effusion with contralateral mediastinal shift, USG-right massive pleural effusion with pleural thickening  with normal abdomen pelvis. CECT THORAX- Nodular thickening of mediastinal and right parietal pleura which takes enhancement with right gross pleural effusion. Pleural fluid reveals – cytology show lymphocytosis and no malignant cell found. Biochemical test found low ADA exudative with high LDH, THORACOSCOPY -Gross appearance showed multiple white and grey nodules over both visceral and parietal pleura. Biopsy taken and h/p study confirms malignant mesothelioma. Patients referred to radiotherapy department for further management.

Conclusion: Though patient has no history of exposure to asbestos. So other risk factor present in the soil or his firm may be responsible for the development of malignant Mesothelioma.

Keywords: Mesothelioma, Thoracocentesis, Thoracoscopy and Mediastinum.

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Dr Bhabani Sankar Rout

Department of Pulmonary Medicine, VSSIMSAR, Burla