Question

A 69-year-old man presents with a 7 - 10 day history of increasing dyspnea and inspiratory chest pain. He has a 2-pack-per-day smoking history and abuses alcohol. He has hypertension, diabetes, coronary artery disease, and chronic kidney disease. Upon further questioning, you discover that he was discharged from the hospital 2.5 weeks ago; he was diagnosed with congestive heart failure after presenting with similar symptoms. The patient's breathing appears labored, and you note diminished breath sounds on auscultation and dullness to percussion in the lower half of the lung fields bilaterally. A chest X-ray reveals bilateral moderate pleural effusions. Thoracentesis reveals pleural fluid with the following characteristics: (1) turbid in appearance; (2) 2500 white blood cells/microliter; (3) glucose equal to serum levels; (4) ratio of pleural fluid protein to serum protein of 0.75; and (5) ratio of pleural fluid LDH to serum LDH of 0.72.

Based on the information above, what is the most likely etiology of the pleural effusions?

1. Congestive Heart Failure
2. Nephrotic Syndrome
3. Cirrhosis
4. Malignancy
5. Bacterial pneumonia

Answer 1

The most likely etiology of the pleural effusions is Congestive Heart Failure. Pulmonary edema is a common symptom of heart failure that can lead to excess fluid in the air sacs of the lungs.

Step-by-step explanation:

The most likely etiology of the pleural effusions in this case is Congestive Heart Failure. Pulmonary edema, which is excess fluid in the air sacs of the lungs, is a common symptom of heart failure. The patient's symptoms, medical history, and physical examination findings are consistent with heart failure. Additionally, the pleural fluid characteristics, such as turbidity, elevated white blood cells count, and the protein and LDH ratios, are indicative of a transudative pleural effusion caused by heart failure.