28th February 2025

A 78-year-old gentleman presents to A&E with gradually worsening shortness of breath, pleuritic chest pain

A 78-year-old gentleman presents to A&E with gradually worsening shortness of breath, pleuritic chest pain, unintentional weight loss and fatigue. He denies any infectious symptoms or recent travel. His past medical history includes hypertension, type two diabetes and hypercholesterolemia. His medications include atorvastatin, metformin and ramipril.

His saturations are 92% on room air which improves to 95% on 2L of oxygen via nasal cannulae. There is dullness to percussion and reduced breath sounds on the right mid zone and base. A chest X-ray shows a right-sided pleural effusion. He undergoes diagnostic thoracentesis. Blood tests show a normal serum level protein.

Which of the following pleural tap results would be suggestive of malignancy in this patient?

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