Pleural Fibroma Presenting as Spontaneous Pneumothorax in Late Pregnancy, an Exceedingly Rare Co-occurrence: A Case Report

Abstract

Introduction: Pleural fibroma or solitary fibrous tumor of the pleura (SFTP), a pleural tumor with malignancy risk presenting as pneumothorax is rare.  In addition, spontaneous pneumothorax occurring in pregnancy is an uncommonly encountered scenario. We report a rare co-occurrence of a pleural fibroma causing spontaneous pneumothorax in a pregnant patient and review literature pertaining to these uncommon conditions. Case Presentation:  This is a 42-year-old lady in her third trimester with gestational diabetes mellitus (GDM) and hypertension who presents with sudden-onset dyspnea. Clinical examination was suggestive of a right-sided pneumothorax which was confirmed with a chest X-Ray. Chest X-Ray also revealed supradiaphragmatic right pleural base lesion which was well-circumscribed. A chest tube was inserted and continued to drain for another 11 days and was finally removed. A CT Thorax done due to persistent air leak after 3 days of chest drainage revealed a homogenously enhancing soft tissue density at the right pleural base which was suggestive of a pleural fibroma. This patient delivered a healthy term baby girl. She was offered right thoracoscopic surgery, but she declined. At one-year follow-up, she was keeping well. Discussion and Conclusion: Due to the scarcity of such cases, high-level evidence is lacking. The authors review previously published literature and discuss the indications and timing of surgical intervention in both these conditions. We outline general principles of management for spontaneous pneumothorax in pregnancy and SFTP. We place emphasis that every case should be managed in a multidisciplinary, individualized fashion with decision-making shared by the well-informed patient.