A 56 year old woman presents with worsening dyspnea and abdominal distention for 8 months.

Her medical history is unremarkable, while her menopause took place at 52 years of age. She has had 3 uneventful pregnancies.

A full blood count and chest x-ray show a hemoglobin level of 13 g/dl and a right sided pleural effusion respectively. A recent mammogram was normal.