A rare cause of oedema.

An 82-year-old man had progressive oedema and dyspnoea. His past medical history was notable for sick sinus syndrome, for which he had received a pacemaker 3 years earlier. A chest radiograph showed pulmonary oedema with a normal cardiac silhouette (not shown). Massive pleural effusions developed, as shown on repeat chest radiograph 2 months later (Figure 1). He had marked ascites and swelling of the scrotum and legs. Diagnostic evaluations including laboratory tests and imaging techniques had been