Endobronchial Diagnosis of a Malignant Mesothelioma

Malignant mesothelioma (MM) originates in the serosal membranes of thoracic and abdominal cavities. The close association of this malignancy with asbestos exposure is well known.1 The commonest type of MM arises in pleura, which comprises >90% of cases of MM. Thoracoscopy-guided pleural biopsy is the preferred technique with high diagnostic yield of 80% to 90%.2 A 64-year-old man, with a background history of asbestos exposure, presented with a 4-month history of dry cough. This was associated with chest tightness and shortness of breath. He was a nonsmoker. At presentation, respiratory examination revealed dullness on percussion with reduced breath sounds in the posterior aspect of the right lower chest. Chest radiograph confirmed a moderate sized right pleural effusion. Computed tomographic scan of the chest showed pleural plaques, and partial collapse of right lower lobe with a pleural effusion. Pleural aspirate of 500 mL, was straw colored, exudative and negative for malignant cells and microbiologic studies. A video-assisted thoracoscopic surgery (VATS) was performed and biopsies confirmed benign asbestos-related fibrinous pleuritis