Correct!
3. His pleural effusion is most likely due to metastatic prostrate cancer

His chest x-ray shows bilateral pleural effusions right greater than left. A NT-pro BNP of <300 pg/ml has a 98% negative predictive value in excluding acute heart failure (1). Prostate cancer most commonly metastasizes to regional lymph nodes and bone (2). Pleural metastases are rare. Nearly half of patients with symptoms of heart failure are found to have a normal left ventricular (LV) ejection fraction (3). Similarly, radiographic variables on chest x-ray have high specificity (79-99%) but modest sensitivity (1-54%) for the diagnosis of heart failure (4). Chest CT could provide clues to the diagnosis such as suggesting an endobronchial obstruction, pleural metastasis, etc. and was therefore performed (Figure 2).

Figure 2. Representative image from thoracic CT scan.

Which of the following is false?

1. The patient’s CT scan shows bilateral pleural effusions right larger than left
2. The whitish area in the region of the liver most likely represents a metastasis
3. The most common cause of bilateral pleural effusions is heart failure
4. Thoracentesis will be necessary to separate a transudate from an exudate in this patient
5. Transudates are most commonly due to congestive heart failure

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