Differential Diagnosis
- Single most likely diagnosis
- Hepatic hydrothorax: This is the most likely diagnosis given the patient's history of alcohol-associated cirrhosis and the presence of a right pleural effusion. The lack of jugular venous distension and the characteristics of the pleural fluid (low protein and lactate dehydrogenase levels) also support this diagnosis.
- Other Likely diagnoses
- Malignant pleural effusion: Although the patient was told she was in remission from breast cancer, the possibility of recurrence cannot be ruled out. However, the characteristics of the pleural fluid do not strongly support this diagnosis.
- Tuberculosis pleuritis: The patient has a history of a positive PPD skin test, but she was treated with isoniazid 20 years ago, making this diagnosis less likely. However, it is still possible, especially if the treatment was not effective or if she was re-exposed to TB.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Empyema: Although the patient does not have symptoms of infection, such as fever or purulent discharge, empyema is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Pulmonary embolism: The patient has a history of cancer and cirrhosis, which increase her risk of thromboembolic events. Although the presentation is not typical, pulmonary embolism is a diagnosis that should not be missed.
- Rare diagnoses
- Chylothorax: This is a rare condition characterized by the accumulation of chyle in the pleural space. It is often associated with lymphoma or other malignancies, but it can also occur in patients with cirrhosis.
- Amyloidosis: This is a rare condition characterized by the deposition of amyloid protein in various tissues, including the lungs. It can cause pleural effusions, but it is a rare diagnosis that would require further evaluation to confirm.