75 yr old non smoker in otherwise good health presents with persistent cough. He has a remote history of asbestos exposure. Physical exam is unremarkable aside from dullness to percussion and decreased breath sounds in the R lung base.
CT of the chest reveals R pleural thickening and loculated R sided pleural effusion. There are 2 cm R hilar nodes and 2 cm ipsilateral mediastinal lymph nodes.
Pleural biopsy reveals mesothelioma.