Pleural effusion - unilateral - malignant
Shortness of breath.
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Large unilateral right sided effusion. The heart is enlarged, especially the left atrial appendage. Although it is difficult to appreciate, the right breast shadow is absent.
The patient went on to have a pleural aspiration which demonstrated the presence of malignant cells, secondary to prior breast cancer. Up to this point, there was no history of metastatic disease.
When faced with a large unilateral pleural effusion one should always consider the possibility of a malignant effusion and perform a diagnostic pleural tap.