Delayed

An 85 year old man presents with progressive dyspnea, fatigue and anorexia for three months. He also experienced pain in the lower right side of his chest during this time.

He was a shipyard worker for 30 years, retiring at the age of 55.

His medical history is unremarkable. There is no family history of lung disease.

Select Relevant Investigations
X-ray Chest

Performed

There is a moderate pleural effusion in the right hemi-thorax.
Pleurocentesis

Performed

Protein: 3.5 g/dL
Pleu. fluid:Serum protein: 0.67
LDH: 240 IU/L
Pleu. fluid:Serum LDH: 0.7
AFB: -ve
IFN-gamma release test: -ve
Gram stain & culture: -ve
Cytology: +ve for malignant cells
CT Chest (Contrast)

Performed

A moderate right sided pleural effusion is noted. A nodular mass contiguous with the right parietal pleura is seen. There is no mediastinal lymphadenopathy.
CT guided biopsy

Performed

Histology of the biopsy sample is suggestive of a malignant mesothelioma of the epithelioid type. There is no evidence of vascular or lymphatic invasion, and regional lymph nodes are negative for disease.

Select Relevant Management
R/s Pneumonectomy
Antituberculous therapy
Chemical pleurodesis
Radiotherapy