We entirely agree that neither pleuroscopy nor VATS is necessarily mandated for diagnostic purposes in patients with unequivocal pseudochylothorax with a clear etiology, such as rheumatoid arthritis. Unfortunately, the clinical scenario frequently is not so clear cut particularly because TB causes the majority (54%) of pseudochylothoraces worldwide.2 Physicians therefore should always consider alternative diagnoses, such as TB, particularly in patients who are relatively immunosuppressed due to treatment of rheumatoid arthritis. Where there is any diagnostic doubt, an outpatient pleuroscopy is a one-stop procedure to obtain pleural biopsy specimens and achieve pleural volume control. However, one particular question remains: How often do pleural biopsy specimens add diagnostically useful information in cases with grossly thickened pleura vs those with relatively normal pleura? It is conceivable that biopsy specimens from intensely thickened pleura are less likely to be helpful, potentially yielding fibrous tissue rather than findings characteristic of a specific underlying disease.