CASE REPORT
Diagnosis: Mesothelioma - HD
A 53-year-old woman presented in September 1991 to Adiyaman State Hospital with pain on the left side of the chest, dyspnoea, and dry cough. Chest radiograph, taken on 22 October 1991 ( Appendix HD1 ), and medical examination revealed fluid accumulation in the left pleural cavity, and she was referred to a specialized medical center in Istanbul.
The patient was admitted to Heybeliada Sanatorium for Chest Diseases and Chest Surgery [HSCDCS] on 4 November 1991 ( Appendix HD2 ). Chest radiograph showed at left side up to the top a homogenous density increase that pushed the heart and the mediastinum to the right. Some of the laboratory findings are listed in Appendix HD2. Thoracoscopy demonstrated tumoral tissue; pleural biopsy was performed; histopathological examination of the specimen revealed the diagnosis as "poorly differentiated fibrous malignant mesothelioma." One ampoule of Coparvacs was administered following the thoracoscopy. No expansion of the lung was observed. A 1x1 cm lymph node was discovered on the left of the neck at the supraclavicular site. A total of 4,500 mL of serofibrinous fluid was removed until the patient was discharged on 2 December 1991.
The patient presented to Dr. Ozel on 11 December 1991 with a chest x-ray taken on 22 October 1991 ( Appendix HD1 ), and the medical report issued at HSCDCS ( Appendix HD2 ). On examination she was distressed and short of breath. There was dullness up to the top in the left hemithorax. No sound of respiration was audible over the left lung. Each movement caused dyspnea and tachycardia, and she could only move with help. Edema was present from the left hemithorax to the lodge of the spleen. There was a 1x1 cm node at the supraclavicular site. The patient had experienced extreme loss of weight. A test dose of 0.3cc N.O.I. caused the body temperature of the patient to increase to 38° C, and the patient was placed on a daily regimen of 0.3cc NOI to be given six times a week.
The patient presented to Dr. Ozel on 2 February 1992 with an x-ray taken on 31 January ( Appendix HD3 ). The radiograph showed that the density increase persisted only in the lower half of the lung. On physical examination, there was no edema present. She experienced no more dyspnea and could move around alone without any support. Mediate auscultation demonstrated participation of the upper half of the left lung in breathing. Dullness still persisted in the lower half of the hemithorax. The patient was recommended to continue on the same regimen for another sixty days.
The patient presented to Dr. Ozel on 9 April 1992 with a roentgenogram taken the previous day ( Appendix HD4 ). The x-ray showed that the high density region was limited to lower one-third of the left lung. On physical examination, breathing sound was less audible over the lower third of the left lung. The patient reported no specific complaint. The general condition of the patient had improved considerably, and she could perform her daily routine activities as a healthy person. She was advised to continue on the same regimen.
The injections started to cause no fever after 15 May 1992, and the patient was placed on a maintenace regimen of 0.3cc N.O.I. to be given every three days.
The patient presented to Dr. Ozel on 10 August 1992 with an x-ray taken on the same day. The reontgenogram showed a return to normal with the exception of a blockage of the left sinus. On physical examination, breathing sound was audible over the whole of the left lung. The patient was in complete health and was recommended to stop the treatment.
Another follow up x-ray was taken on 28 June 1994 ( Appendix HD5 ). Blockage of the left sinus was still present, but there was no sign of the original disease.
Dr. Ozel last heard from her in 2000; she was in remission.