15th September 2020

A 77-year-old retired firefighter presents with a 1-month history of dyspnoea and chest pain

A 77-year-old retired firefighter presents with a 1-month history of dyspnoea and chest pain. He has never smoked and denies any haemoptysis. His past medical history is unremarkable, but he reports presenting with similar symptoms 3 months ago when he was found to have a right-sided pleural effusion. A thoracentesis was performed, and on analysis, pleural fluid was exudative but could not confirm malignancy on cytology. On examination today, there is reduced air entry on the right side with dullness to percussion. You suspect another pleural effusion. CT chest-abdomen shows right-sided pleural effusion, hilar lymphadenopathy and pleural plaques with irregular pleural thickening.

For the patient above, please select the SINGLE most likely diagnosis. Select ONE option from the list above.