02-29-2008, 01:58 PM
A 42-year-old woman comes to the urgent care clinic complaining of right-sided chest pain. She has shortness of breath, chest pain that is worse with deep breathing, low-grade fever, and a nonproductive cough. She has had the symptoms for the past 5 days. She has no medical history, takes no medications, and has no drug allergies. She does not smoke. Her oxygen saturation is 93% on 2 L NC, blood pressure is 100/85 mm Hg, and pulse is 85/min. Examination is notable for dullness to percussion in the left lower field. She also has a friction rub. Chest x-ray reveals a layering pleural effusion that is 15 mm in size. Diagnostic thoracentesis reveals a pleural fluid-to-serum protein ratio of greater than 0.7. Pleural fluid cholesterol is 80 mg/dL. Cytology is negative. Which of the following is the most likely cause of this effusion?
A. Bacterial pneumonia
B. Cirrhosis
C. Congestive heart failure
D. Malignancy
E. Tuberculosis
A. Bacterial pneumonia
B. Cirrhosis
C. Congestive heart failure
D. Malignancy
E. Tuberculosis