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Malignant pleural mesothelioma — SCE Respiratory MCQ

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HardPleural DiseaseMalignant pleural mesotheliomaSCE Respiratory

A 73-year-old man with asbestos exposure has chest pain, weight loss and a unilateral pleural effusion. CT shows circumferential nodular pleural thickening extending into the fissures and contraction of the hemithorax. Cytology from aspiration is negative. What is the most likely diagnosis?

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Correct answer: B — Malignant pleural mesothelioma

Asbestos exposure plus circumferential nodular pleural thickening and hemithorax contraction is highly suggestive of mesothelioma. Negative cytology does not exclude mesothelioma because cytology sensitivity is limited, so pleural biopsy is often required. Cardiac failure and pulmonary infarction do not produce this pleural rind pattern.

Reference: BTS Pleural Disease Guideline 2023; NICE NG122