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Out of breath

Step 1: View clinicals

A 44-year-old woman presents with progressively worsening dyspnea for one week. There is no history of orthopnea, paroxysmal nocturnal dyspnea, chest pain, or cough. She was completely asymptomatic prior to this, has no comorbidities, and is not on any medications. There is no history of recent trauma. She has never smoked, and only drinks socially. A complete blood count and electrocardiogram (ECG) are found to be completely normal.

Step 2: Order all relevant investigations

Chest X-ray

There is near complete homogeneous opacification of the right hemithorax, with mediastinal shift to the left. The left lung shadow appears normal.

CT Thorax

There is a large right-sided pleural effusion with no loculi. No lung, hilar or mediastinal masses or adenopathy is noted. The mediastinum is shifted towards the left side.


Approximately 1300 cc of a milky white exudate is aspirated. Analysis shows a normal cell count with increased proteins. Triglycerides are present, at a concentration of 120 mg/dL.


A pulmonology consultation in respect of this will be arranged tomorrow.

Step 3: Select appropriate management

IV Antibiotics
Low-fat diet
Intercostal tube
Urgent pleurodesis

Score: ★★☆