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Malignant pleural mesothelioma — RACP Adult Medicine MCQ

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HardRespiratoryMalignant pleural mesotheliomaRACP Adult Medicine

A 74-year-old retired shipyard worker presents with progressive dyspnoea and dull right chest pain. Chest CT shows unilateral pleural thickening encasing the lung with a moderate exudative effusion. Cytology is nondiagnostic. What is the most likely diagnosis?

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Correct answer: D — Malignant pleural mesothelioma

Asbestos exposure with unilateral rind-like pleural thickening and exudative effusion is highly suggestive of mesothelioma, even when cytology is negative. Parapneumonic effusion would usually have infectious features. Heart failure causes transudates, while alveolar proteinosis and asthma do not produce pleural encasement.

Reference: Cancer Australia mesothelioma guidance; TSANZ