A 52-year-old man has productive cough, fever, and right pleuritic pain. CXR: RLL consolidation with moderate pleural effusion. Thoracentesis: pH

Question

A 52-year-old man has productive cough, fever, and right pleuritic pain. CXR: RLL consolidation with moderate pleural effusion. Thoracentesis: pH 7.10, glucose 1.5 mmol/L, LDH 2500, protein 45 g/L, Gram+ cocci in chains. Most appropriate management?

Accepted Answer

Chest tube drainage plus IV antibiotics

Answer

Observation and repeat CXR in 2 weeks

Answer

Thoracotomy with decortication

Answer

IV antibiotics alone

Answer

Repeat thoracentesis in 48 hours

Empyema — MCCQE Part 1 MCQ

A 52-year-old man has productive cough, fever, and right pleuritic pain. CXR: RLL consolidation with moderate pleural effusion. Thoracentesis: pH 7.10, glucose 1.5 mmol/L, LDH 2500, protein 45 g/L, Gram+ cocci in chains. Most appropriate management?