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A 2-year-old girl with tricuspid atresia has increasing respiratory distress for 2

days. She has been recovering uneventfully from an operation 10 days ago to join

systemic venous return with pulmonary arterial circulation. Over the past 4 days,

she has been weaned off mechanical ventilation, started on oral feedings, and

is receiving chest physiotherapy for atelectasis. Her temperature is 37.4 C (99.3 F),

blood pressure is 98/64 mm Hg, pulse is 120/min, and respirations are 46/min.

Examination shows nasal flaring, grunting, and intercostal retractions. An x-ray

film of the chest shows large bilateral pleural effusions. Thoracentesis yields 300

mL of whitish-yellow fluid. The supernatant remains uniformly opaque on

centrifugation. Which of the following is the most likely cause of the pleural


A) Chylothorax

B) Congestive heart failure

C) Empyema

D) Pulmonary embolism

E) Superior vena cava obstruction



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