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Mesothelioma — SCE Respiratory MCQ

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ModeratePleural DiseaseMesotheliomaSCE Respiratory

A 72-year-old retired plumber has chest pain, weight loss and a large unilateral pleural effusion. CT shows circumferential pleural thickening involving the mediastinal pleura. Pleural fluid cytology is negative. What is the most appropriate investigation?

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Correct answer: C — Thoracoscopic pleural biopsy

Circumferential pleural thickening with mediastinal involvement strongly suggests malignant pleural mesothelioma, and thoracoscopic biopsy provides tissue for diagnosis and subtype. Cytology is often insensitive in mesothelioma. Airway tests and D-dimer do not establish pleural malignancy histology.

Reference: BTS Guideline for Malignant Pleural Mesothelioma 2018; BTS Pleural Disease Guideline 2023