Encik...., 52 year old Malay male was admitted on Monday (5.6.2006) with the complains of breathlessness, fever and vomiting for one week duration. Patient has   had similar episodes of breathlessness since May 2005 and was admitted a couple of times. He is a known diabetic for 5 years and is on medication, He also has hypertension for 1 year and has hearth problem since 2005. According to the   patient he had a couple of episodes of chest pain but could not elaborate further.

 Patient also gave history of having renal failure since May 2005.A pleural tap was done one the 14.6.2006 and 800cc of pleural fluid was drawn and according to patient it was serous fluid. The positive findings obtained on examination are, the patient had a raised Jvp and his apex beat was localised in the fifth intercostals space 3 cm lateral to the midclavicular line. An X – ray that was taken after the plural tap revealed a cardiomegally. Based on the findings at this point of time, it shows that the pleural effusion could be caused by pulmonary hypertension due to cardiac failure.

                  The plan of management for this patient is to treat the heart problem and see if the pleural effusion decreases. This is done by decreasing the after load and preload to the heart. The preload can be decreased by diuretics and venodilators like Nitro-glycerine and the after load can be decreased by arterial dilators like hydralazine or ACE inhibitors .At the same time the plural tap that was obtained is also sent for culture and sensitivity, AFB and cytology to rule out other causes of this pleural effusion. Pleural tap report was yet to be obtained.

            Other findings in this patient includes bilateral cataract on both eyes where his vision on his right eye is limited to perception of light and his left eye to counting finger at a distance of 1 meter.