An adult with pneumonia has a non-purulent pleural effusion. Pleural pH is 7.28, LDH 1,140 IU/L, glucose 3.5 mmol/L and ultrasound shows septations;

Question

An adult with pneumonia has a non-purulent pleural effusion. Pleural pH is 7.28, LDH 1,140 IU/L, glucose 3.5 mmol/L and ultrasound shows septations; fever persists despite antibiotics. What does BTS guidance support?

Accepted Answer

Insert an intercostal drain because intermediate pH plus LDH above 900 and septation indicate complicated infection

Answer

Arrange immediate thoracoscopic debridement because any ultrasound septation predicts failure of correctly positioned small-bore tube drainage

Answer

Repeat aspiration only after 72 hours because pH 7.21–7.39 is low risk

Answer

Give intrapleural alteplase before establishing chest-tube drainage

Answer

Antibiotics alone because drainage is considered only when pH is at most 7.20

S. pneumoniae Gram Stain — SCE Infectious Diseases MCQ

An adult with pneumonia has a non-purulent pleural effusion. Pleural pH is 7.28, LDH 1,140 IU/L, glucose 3.5 mmol/L and ultrasound shows septations; fever persists despite antibiotics. What does BTS guidance support?