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Empyema — RACP Adult Medicine MCQ

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ModerateRespiratoryEmpyemaRACP Adult Medicine

A 65-year-old man presents with dyspnoea and a large left-sided pleural effusion. Diagnostic thoracentesis shows: pH 7.15, LDH 1200 U/L, glucose 1.5 mmol/L, protein 45 g/L. Gram stain shows gram-positive cocci. What is the most likely diagnosis?

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Correct answer: C — Empyema

Pleural fluid with pH <7.2, LDH >1000 U/L, glucose <2.2 mmol/L, and positive Gram stain defines empyema (or complicated parapneumonic effusion). This requires intercostal drainage (chest tube) plus IV antibiotics. If drainage is inadequate, intrapleural fibrinolytics (alteplase + DNase) or surgical decortication (VATS) may be required.

Reference: eTG Respiratory – 2024 – Pleural Infection; BTS 2023 Pleural Infection Guidelines