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Mesothelioma is a relatively rare tumour, however continued use of asbestos in the developing world means that worldwide incidence of mesothelioma is expected to continue to increase. Previously, the more invasive procedure techniques were reserved for thoracic surgeons or interventional radiologists, however the increasing use of ultrasound by general physicians has led to an associated expansion in the field of interventional pulmonology available for pleural disease including mesothelioma. Pleural biopsy histology is important in the diagnosis of mesothelioma, and there are various techniques for obtaining pleural biopsies available to the interventional pulmonologist. Evidence-based treatment of mesothelioma relates to chemotherapy/oncological options and supportive care, and the interventional pulmonologist has an important role in the control of symptoms and in pleural effusion control.