11th January 2024

A 76-year-old gentleman presents to the ambulatory care unit with progressive shortness of breath.

A 76-year-old gentleman presents to the ambulatory care unit with progressive shortness of breath. He reports 6 days of increasing shortness of breath on exertion with associated cough, purulent sputum production and fevers. He has no recent travel history. A chest x-ray is completed, which shows left lower zone consolidation with an associated moderate-sized unilateral pleural effusion. A diagnostic aspiration showed the below. 

Investigations:

Pleural pH – 7.26

Protein – 45g/L

MC+S – Negative gram stain, cultures pending. Significant neutrophilia. 

What is the most likely cause of this gentleman’s pleural effusion? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.