19 patients suspected pleural mesothelioma were performed thoracoscopy. The overall diagnostic rate was 94.7% (18/19 cases). The macroscopic findings of 18 cases presented solitary, well circumscribed, smooth, rounded masses in 2 localized cases and multiple, clear, yellowish-white and "grape-like" granulations or malignant pleural thickening in 16 diffuse cases. Biopsy was taken in 18 cases under direct vision. The histological diagnosis showed 2 benign fibromatous mesothelioma and 16 malignant mesothelioma. Pleural mesothelioma was easily misdiagnosed as primary lung cancer, tuberculous pleurisy and metastatic pleural tumor. The diagnostic accuracy by cytological study of pleural effusions and needle biopsy of pleura both were low. Thoracoscopy is currently a suitable diagnostic method for pleural mesothelioma. The resection was considered as a proper treatment of choice for localized pleural mesothelioma. We recommend that thoracoscopic talc poudrage followed by chemotherapy on diffuse malignant mesothelioma with pleural effusion could be used to improve the survival rate and to prevent the recurrent effusion.