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Pulmonary puzzle
A cloudy pleural effusion
  1. Puneet Malhotra1,
  2. John P Watson1,
  3. Paul K Plant1,
  4. Richard Bishop2
  1. 1Department of Respiratory Medicine, St James' University Hospital, Leeds, UK
  2. 2Department of Histopathology, St James' University Hospital, Leeds, UK
  1. Correspondence to Dr Puneet Malhotra, Department of Respiratory Medicine, St James' University Hospital, LS9 7TF Leeds, UK; drpuneetanshu{at}

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Case presentation

A 55-year-old previously fit and well woman was admitted with a 4-week history of dry cough and 1-week history of progressive breathlessness. She had never smoked, was on no regular medications and there was no history of heart disease, malignancy, rheumatological disease or tuberculosis.

Physical examination revealed signs of a moderate right-sided pleural effusion but was otherwise unremarkable. Full blood count, clotting, and renal and liver function tests were normal. C reactive protein was <5 mg/l. Chest x-ray revealed a moderate right sided pleural effusion.

She underwent bedside diagnostic aspiration of 50 ml of pleural fluid …

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