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Recurrent Pleural Effusions, Lymphedema, and Abnormal Nails in a 61‐Year‐Old Man

A 61 year old man with history of hypertension, coronary artery disease (CAD) with prior stent placement, and chronic obstructive pulmonary disease (COPD) presented with a four month history of recurrent pleural effusions and progressive diffuse edema. Four months prior to hospital presentation, the patient began to notice new onset dyspnea on exertion, fatigue, and chest pain. Initial evaluation with troponin and EKG were negative. A chest x-ray (CXR) was done which revealed a moderate sized left pleural effusion. He did not have a history of pleural effusions or heart failure. Therefore, he underwent diagnostic thoracentesis and fluid studies were consistent with an exudative pleural effusion without malignant cells or microbial growth.