Picture quiz: Unilateral pleural effusion with history of asbestos exposure
A previously fit and healthy 67 year old man presented with a two week history of shortness of breath on exertion. He did not have pleuritic chest pain, cough with purulent sputum, or pyrexia. He had worked as a builder in the London docklands 40 years ago and said that he had been heavily exposed to asbestos. He had never smoked. Cardiovascular and abdominal examinations were normal. Expansion of the chest was less on the right side, the right middle to lower region was stony dull on percussion, and no breath sounds were heard in the corresponding area. Full blood count, liver function tests, and biochemistry were within normal parameters. His chest radiograph is shown in fig 1.
A proved malignant effusion from cytological analysis of pleural fluid requires expert opinion from the thoracic multidisciplinary team. But an accurate diagnosis of mesothelioma is important for several reasons, not least for