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Empyema Management — RACP Paediatrics MCQ

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HardRespiratoryEmpyema ManagementRACP Paediatrics

A 4-year-old presents with a 2-day history of increasing respiratory distress. CXR shows a large right-sided pleural effusion with mediastinal shift. He has had fever for 5 days and was initially treated for pneumonia. Pleural fluid shows pH 6.9, glucose 1.5 mmol/L, LDH 3500 U/L. What is the most appropriate management?

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Correct answer: A — Chest drain insertion with intrapleural fibrinolytic therapy

Empyema (complicated parapneumonic effusion) with biochemical features of infection (low pH, low glucose, high LDH) requires chest drain insertion. Intrapleural fibrinolytics (urokinase or alteplase) improve drainage and reduce the need for surgery.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Parapneumonic Effusion and Empyema