MSFinals-5824

MSFinals-5824

A 50-year-old woman presents to her General Practitioner with increasing shortness of breath. She has also suffered from dull right iliac fossa pain over the past few months. Past history of note includes tuberculosis at the age of 23 and rheumatoid arthritis. On examination, her right chest is dull to percussion, consistent with a pleural effusion, and her abdomen appears swollen with a positive fluid thrill test. She may have a right adnexal mass.
Investigations:
Investigation
Result
Normal value
Chest X-ray Large right-sided pleural effusion
Haemoglobin 115 g/l 115–155 g/l
White cell count (WCC) 6.8 × 109/l 4–11 × 109/l
Platelets 335 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 5.4 mmol/l 3.5–5.0 mmol/l
Creatinine 175 μmol/l 50–120 µmol/l
Bilirubin 28 μmol/l 2–17 µmol/l
Alanine aminotransferase 25 IU/l 5–30 IU/l
Albumin 40 g/l 35–55 g/l
CA-125 250 u/ml 0–35 u/ml
Pleural aspirate: occasional normal pleural cells, no white cells, protein 24 g/l.
Which of the following is the most likely diagnosis?