A 60-year-old man comes to the physician because of a 3-month history of progressive shortness of breath and swelling of his legs and feet. His difficulty breathing often awakens him at night, and he has to sleep propped up on pillows. His respirations are 24/min. Bilateral crackles are heard on auscultation of the chest. There are decreased breath sounds and dullness to percussion at the lung bases. Physical examination shows 2+ edema of the lower extremities, including the feet. A chest x-ray shows cardiomegaly, bilateral pleural effusions, and increased pulmonary vasculature. Which of the following is the most likely mechanism of the pleural fluid formation in this patient?

1. Blockade of lymphatic drainage from the pleural space
2. Decreased plasma oncotic pressure, allowing movement of fluid into the pleural space
3. Direct movement of fluid through defects in the diaphragm into the pleural space
4. Increased fluid from thoracic duct obstruction
5. Increased fluid movement from the lung interstitial space into the pleural space

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