Explore a rare case of a 67-year-old woman presenting with yellow nails, Dyspnea, and pitting edema, leading to a surprising systemic diagnosis.
A 67-year-old woman with a history of chronic rhinosinusitis presented to the emergency department with a 1-week history of dyspnea and cough. On physical examination, all 10 fingernails were yellow and thickened (upper image). Pitting edema was also present in the legs (lower image), and decreased breath sounds were detected at the left lung base. A chest radiograph showed a pleural effusion on the left side. A thoracentesis was performed, and 1.1 liters of milky, yellow fluid were removed. Findings from analysis of the pleural effusion were consistent with a chylous effusion. What single diagnosis could explain all of this patient’s findings?
What is the most likely diagnosis?
Chylothorax, Lymphedema, Pleural Effusion, Xanthonychia, Yellow nail syndrome