Pseudomesotheliomatous Pleural Effusion

Clinical History

A 91 year old male presented with complaints of dyspnoea, cough and weakness. A radiograph of the chest showed infiltrates in the right middle lobe, bilateral pleural effusions and marked pleural thickening. Because the pneumonic infiltrates had the radiologic features of a pneumonia, the patient was started on appropriate antibiotic therapy. The antibiotics caused a partial resolution of the pneumonic infiltrates. Diagnostic pleuorocentesis was performed.

Pleurocentesis yielded 1700 mls of serous fluid. Portions of the pleural fluid were tested for tumor markers. The pleural fluid was negative for CA19-9 tumor marker and showed an elevated CEA (carcinoembryonic antigen level) of 78.7 ng/ml. The serum CEA level was not elevated. Samples of the pleural fluid were also submitted for cytologic examination as well as electron microscopy (EM).