21st February 2025

An 82-year-old retired dock worker is admitted to the acute medical unit, having presented to A&E with a 2-week history of worsening breathlessness on a background of 3 months of weight loss and occasional fevers.

An 82-year-old retired dock worker is admitted to the acute medical unit, having presented to A&E with a 2-week history of worsening breathlessness on a background of 3 months of weight loss and occasional fevers. A CT chest carried out in A&E demonstrates a large unilateral pleural effusion, hilar lymphadenopathy and an area of bulky nodular pleural thickening. The effusion is drained and the fluid sent for cytology which is unfortunately not diagnostic. The patient has a background of dementia as well as severe COPD with home nebulisers and LTOT (long-term oxygen therapy).  For the last 6 months, he has required a QDS package of care and has spent most of his time in bed due to breathlessness and fatigue.
The medical team explain to the patient that they are concerned he may have mesothelioma given his previous asbestos exposure, though they have not been able to confirm it yet.

What is the most appropriate next step in management? 

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