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Pulmonary puzzles
A hormonal effusion?
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  1. Charles Sharp1,
  2. Mark Meller2,
  3. Alison Moody2,
  4. George Hands2
  1. 1Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  2. 2Department of Respiratory Medicine, Northern Devon Healthcare NHS Trust, Barnstaple, UK
  1. Correspondence to Dr Charles Sharp, Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK; charles.sharp{at}doctors.org.uk

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A 51-year-old woman presented to the chest clinic with history of progressive dyspnoea and dry cough for 8 weeks. Her past medical history was remarkable for sleeve gastrectomy 3 months ago, which resulted in loss of three stones. She also reported migraines for which she had an implanted occipital nerve stimulator and had undergone hysterectomy with bilateral salpingo-oophorectomy 18 months ago. Other history included hypothyroidism, hypertension and depression. Her medications were Hormone Replacement Therapy (HRT), Nifedipine, Losartan, Levothyroxine, Lansoprazole, Simvastatin and Fluoxetine. She had smoked for 3 years in her 20s, no more than 3–5 cigarettes per day and had no noteworthy occupational exposure. She had a family history of maternal myelodysplasia and …

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