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A transient pleural effusion
  1. M B Frenz
  1. Milton Keynes General Hospital, Milton Keynes, Buckinghamshire, UK
  1. Dr Markus B Frenz, Wycombe Hospital, Queen Alexandra Road, High Wycombe, Bucks HP11 2TT, UKMfrenz1107{at}aol.com

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A 29 year old Tanzanian man, resident in Great Britain for five years, presented complaining of persistent cough. He had been an insulin dependent diabetic for two years and was well controlled. A chest radiograph showed a moderate left pleural effusion (fig 1). He was followed up in clinic without further investigations and a repeat chest radiograph nine months later showed resolution of the effusion (fig 2). He returned five months later acutely unwell. He had lost 5 kg in the previous four weeks and had developed night sweats. Three days before admission he had developed severe headache and vomiting. On examination he was jaundiced, weak, and cachectic. His temperature was 38.7°C. Examination of the cardiovascular and respiratory systems were normal. His liver was enlarged 1 cm below the costal margin. There was no meningism, no papilloedema, and there were no focal neurological signs.

Figure 1

Chest radiograph taken at initial presentation.

Figure 2

Chest radiograph nine months after initial presentation.

Questions

(1)
What are the possible causes of a spontaneously resolving pleural effusion?
(2)
Name one radiological and one diagnostic procedure that would help in making a diagnosis.
(3)
What is the most likely cause of his acute illness and how would you treat him?

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