Successful Diagnostic Confirmation of Malignant Pleural Mesothelioma With Extensive Pleural Adhesions Using Pleural...

Local anaesthesia thoracoscopy using flex-rigid thoracoscope is useful for diagnosing pleural lesions, but it is generally not indicated in cases with extensive pleural adhesions. We report a case of malignant pleural mesothelioma (MPM) with extensive pleural adhesions that was safely diagnosed using pleural cryobiopsy under local anaesthesia. A 65-year-old man with a history of asbestos exposure presented with chest pain and significant weight loss. A very small amount of pleural effusion, narrowing of the left lower intercostal spaces on chest computed tomography (CT) and negative lung sliding sign on transthoracic echocardiography (TTE) indicated significant pleural adhesions. Considering the high risk of general anaesthesia, biopsy under minimally invasive local anaesthesia was chosen. Precise localization of the lesions using positron emission tomography-CT and TTE enables making the incision over the tumour. After minimal adhesion dissection, pleural cryobiopsy was performed and a definitive diagnosis of epithelial MPM was made.