17th February 2025

A 27-year-old man presents to A&E with increasing shortness of breath, leg swelling and chronic productive cough.

A 27-year-old man presents to A&E with increasing shortness of breath, leg swelling and chronic productive cough. On examination, he has thickened yellowing nails, bilateral chest crackles with reduced air entry at the right base and normal heart sounds. He has bilateral pitting oedema to the mid shins. His chest X-ray shows a moderate right sided pleural effusion. 

What is the most likely underlying diagnosis?

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