Pleural effusion Quiz: Ace Your Exams

A 68-year-old woman with a history of heart failure and hypertension presents to the emergency department with increasing dyspnea and a nonproductive cough over the past week. She has required the use of two additional pillows to sleep at night. The symptoms started when she was unable to refill her prescription for furosemide. Temperature is 37.4 °C (99.3 ℉), pulse is 98/min, blood pressure is 148/88 mmHg, respiratory rate is 14/min, and oxygen saturation is 91% on room air. On physical examination, rales are noted throughout the lung fields, except at the right lung base where there are diminished breath sounds. Dullness to percussion is also noted at the right base. Her chest X-ray demonstrates cardiomegaly, bat wing opacities, Kerley B lines, as well as a uniformly white opacity of the right lung base that obscures the outline of the diaphragm and results in a meniscus sign. What is the best next step in management?