Differential Diagnosis for 45y/f with Massive Pleural Effusion
- Single most likely diagnosis
- Metastatic Phylodes Tumor: Given the patient's history of Phylodes Tumor on the right side, the most likely cause of the massive pleural effusion on the left side could be metastasis from the primary tumor. Phylodes tumors, although rare, can metastasize, and the exudative nature of the effusion supports a malignant cause.
- Other Likely diagnoses
- Lymphoma: The high ADA (Adenosine Deaminase) level of 79 suggests lymphoma as a possible cause, especially given that lymphoma can cause exudative pleural effusions. However, the patient's history of Phylodes Tumor makes metastasis a more direct consideration.
- Tuberculosis (TB): Although less likely given the context, TB can cause exudative pleural effusions with high ADA levels. It's essential to consider TB, especially if the patient has risk factors or exposure history.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism (PE): While the presentation does not strongly suggest PE, it's crucial to consider this diagnosis due to its high mortality rate if missed. Massive pleural effusion can be a complication of PE, although it's less common.
- Malignant Mesothelioma: Given the exudative nature of the effusion and the potential for malignancy, mesothelioma should be considered, especially if there's any history of asbestos exposure.
- Rare diagnoses
- Eosinophilic Pleural Effusion: This condition can cause exudative effusions but is relatively rare. It might be considered if other diagnoses are ruled out and there's an appropriate clinical context (e.g., parasitic infection, drug reaction).
- Chylothorax: Although more commonly associated with lymphatic obstruction or trauma, chylothorax can cause a massive pleural effusion. It's less likely given the exudative and high ADA characteristics but remains a rare possibility if other causes are excluded.