Can pneumothorax unveil malignant pleural mesothelioma? A case report and literary review

Malignant pleural mesothelioma is an aggressive cancer with an ominous prognosis due to the absence of effective treatments. MPM diagnosis is often delayed consequently to insidious and non-specific symptoms. Past asbestos exposure represents the major risk factor for MPM onset, although the carcinogenic mechanisms of asbestos is not fully understood. In those cases, the parietal pleura is the target of disease arousal. As opposite, here we present and discuss two clinical cases of MPM who firstly presented as primary spontaneous pneumothorax. In both cases lung nodules where detected, allowing in one of them a misdiagnosis of lung cancer. None of the patients referred exposure to asbestos fibers. We strongly suggest considering MPM among the differential diagnosis of spontaneous pneumothorax in elderly population. Moreover, in this setting, a main pathogenic involvement of the visceral pleura can be hypothesized.