Image of the Week: Recurrent pleural effusions and yellow nails - Clinical Advisor

Image of the Week: Recurrent pleural effusions and yellow nails

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A 58-year-old man with a history of recurrent pleural effusions presents with worsening dyspnea and lower extremity edema. Examination reveals bilateral pitting edema of his legs and feet and yellow, dystrophic nails on his fingers and toes. Chest X-ray demonstrates a large right pleural effusion. A diagnosis of yellow nail syndrome is suspected and thoracentesis is performed. Which of the following characteristics would you expect to find on pleural fluid analysis?

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