An 18-Month-Old Boy Is Admitted to the Pediatric Intensive Care

An 18-month-old boy is admitted to the pediatric intensive care unit after undergoing cardiac surgery.  At age 16 months, his parents brought him to a pediatrician due to intermittent episodes of cyanosis when he became upset.  At that time, a cardiac murmur was noted, and echocardiogram revealed tetralogy of Fallot with moderate pulmonary stenosis.  The patient's initial postoperative period is unremarkable, but on postoperative day 4 he develops tachypnea with an increasing oxygen requirement.  Chest x-ray reveals significant pleural fluid in the right hemithorax.  Analyses of serum and pleural fluid obtained by thoracentesis are as follows: Which of the following is the most likely mechanism causing this patient's pleural effusion?

A) Bacterial infection of the pleural cavity
B) Blood loss into the pleural cavity
C) Decreased plasma oncotic pressure
D) Disruption of the thoracic duct
E) Increased pulmonary vascular pressures
F) Transudation of ascitic fluid through the diaphragm

Correct Answer:

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