Abstract
A 34 year old man was referred to our hospital for further examination of progressive dyspnea and bilateral bloody pleural effusion. He had no apparent history of asbestos exposure. Physical and X-ray examinations were consistent with bilateral pleural effusion and pleural thickening. The results of other physical examinations and the laboratory findings, including sputum studies, upper-gastrointestinal series and abdominal ultrasonography were normal. Pleural cytology and closed pleural biopsy study were negative. The patient received thoracoscopy with a fiberoptic bronchoscope (TFB) under local anesthesia on the 14th hospital day. Both sides of the pleura were covered with discrete, flattened, white nodules. Three biopsies from these nodules disclosed epithelial type of malignant mesothelioma (MMT). Bilateral chest tube drainage was performed and cisplatin and adriamycin were administered through chest tubes. Thereafter the patient was treated with 2 courses of systemic chemotherapy of adriamycin and cisplatin. There was no response and the patient died from respiratory failure 3 months later. The diagnosis of MMT is, in general, difficult to make and in many cases it would take weeks or months to obtain a pathological diagnosis. TFB can be done under local anesthesia with the guidance of fuoroscope. The complication of TFB is minimal and no death has been reported in the literature. We conclude that TFB is a safe and useful procedure to diagnose MMT and should be done in patients with pleural effusion of unknown etiology as early as possible.
