21st February 2025

An 82-year-old man with dementia is brought to A&E by his daughter, who is concerned that his breathing has appeared more laboured over the last 48 hours.

An 82-year-old man with dementia is brought to A&E by his daughter, who is concerned that his breathing has appeared more laboured over the last 48 hours.

On examination, he is tachypnoeic with reduced air entry and dull percussion notes at both bases. He has a raised JVP and an audible systolic murmur. His chest X-ray demonstrates bilateral small pleural effusions with bilateral patchy shadowing.

His daughter tells you he has a long list of medical conditions including type 2 diabetes, chronic kidney disease, ischaemic heart disease, osteoarthritis, glaucoma and vascular dementia. 

Which would be the most useful investigation to guide management of the effusions?

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