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21st February 2025
A 74-year-old woman is referred to hospital by her GP after presenting with worsening breathlessness over the last week.
A 74-year-old woman is referred to hospital by her GP after presenting with worsening breathlessness over the last week. On presentation to A&E, her temperature is 37.2°C, heart rate 93 bpm, blood pressure 140/93 mmHg, oxygen saturations 89% on room air and respiratory rate 26/minute. She has a past medical history of type 2 diabetes mellitus, hypertension and ischaemic heart disease. The results of her initial investigations are detailed below.
| Chest X-ray | Bilateral pleural effusions (right larger than left), upper lobe diversion and patchy interstitial changes. |
| Blood results | |
| Haemoglobin: 120 g/L (115-165 g/L) White cell count: 4.5 x 10⁹/L (3.6-11.0 x 10⁹/L) Platelet count: 250 x 10⁹/L (140-400 x 10⁹/L)NT-pro-BNP: 4200 pg/mL (<400 pg/mL) |
Sodium: 131 mmol/L (133-146 mmol/L) Potassium: 3.7 mmol/L (3.5-5.3 mmol/L) Creatinine: 91 μmol/L (45-84 μmol/ L) eGFR: 52 mmL/min/1.73 m² |
What is the most appropriate next stage in management of her effusions?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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