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


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


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)


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


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