Question

An 87-year-old woman presents with progressive shortness of breath. She has been in a wheelchair for 15 years due to paralysis of her lower extremities from unknown causes. At this time, she is unable to transfer from the chair to her wheelchair without having dyspnea. She is extremely tired, but denies chest pain, palpitations, cough, hemoptysis, dysphagia, hoarseness, or sick exposures. She has never smoked. Her past medical history is positive for hypertension (treated with enalapril), heart failure, chronic kidney disease, hepatitis C, breast cancer, s/p lumpectomy, and radiation treatment 10 years ago. You order a chest X-ray.

What in her medical history would lead you to suspect an exudative pleural effusion?

1. Breast cancer
2. Chronic kidney disease
3. Cirrhosis
4. Heart failure
5. Hypertension

Answer 1

The conditions in the patient's history that raise suspicion for an exudative pleural effusion include her past breast cancer, chronic kidney disease, and heart failure. Each of these conditions has mechanisms that can lead to pleural effusion.

Step-by-step explanation:

In the case of the 87-year-old woman presenting with progressive shortness of breath, an exudative pleural effusion could be suspected due to several factors in her medical history. The most relevant conditions that are known to be associated with pleural effusions of this type are her history of breast cancer, chronic kidney disease, and heart failure. Breast cancer can lead to a pleural effusion as a result of metastatic disease or lymphatic obstruction. Chronic kidney disease may contribute to pleural effusion due to an imbalance in fluid regulation, especially when nearing the end stages of the disease. Lastly, heart failure is a common cause of pleural effusion due to increased hydrostatic pressure in the blood vessels, leading to fluid accumulation in the pleural space.