11th January 2024

A 63-year-old gentleman presents to two-week-wait respiratory clinic with chest pain and prolonged cough.

A 63-year-old gentleman presents to two-week-wait respiratory clinic with chest pain and prolonged cough. He has had progressively worsening symptoms for the last 3 months but was prompted to see his GP when he had a single episode of haemoptysis. He denies any weight loss. He has worked as a welder for the last 45 years and smokes 30/day. He has no other medical problems and describes an unlimited exercise tolerance, walking his dog up to 6 miles a day with ease. 

He undergoes some investigations. 

Investigations: 

CXR: Bilateral calcified lesions of the pleura. Irregular appearance to the pleura at right hemidiaphragm. 

CT Thorax: Irregular mass arriving from the pleural at the right pleural space. Highly suspicious for malignant process. Small pleural effusion associated. Estimated volume <100mL.

Given the likely diagnosis, what is the single best diagnostic investigation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.