11th January 2024

An 84-year-old lady is an inpatient on the cardiology ward being treated for decompensated congestive cardiac failure.

An 84-year-old lady is an inpatient on the cardiology ward being treated for decompensated congestive cardiac failure. She has ongoing shortness of breath despite IV diuresis and is noted to have large bilateral pleural effusions. A diagnostic aspiration is completed. 

Investigations: 

Pleural pH 7.63 

Pleural protein level: 14g/L. 

Pleural LDH: 34units/L. 

Pleural M, C+ S: Negative gram stain, negative culture. Minimal leucocytes. 

What is the underlying pathophysiological mechanism that has led to this lady’s pleural effusion? 

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