Malignant mesothelioma may present with recurrent pleural effusion despite repeated aspirations. Especially in old patients with recurrent pleural effusion causing chest pain and dyspnea discordant with its amount, malignant mesothelioma should be thought in the differential diagnosis. In this case, we presented the radiological findings and computed tomography images of a patient with malignant mesothelioma and progressive pleural effusion, in whom malignant cells were not detected at the initial thoracentesis.