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Empyema complicating pneumonia — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsEmpyema complicating pneumoniaSCE Acute Medicine

A 58-year-old man has persistent fever and pleuritic pain five days after admission with left lower-lobe pneumonia. CRP remains 260 mg/L despite appropriate antibiotics. Ultrasound shows a large septated pleural effusion and diagnostic aspiration yields turbid fluid with pH 7.08 and low glucose. What is the most appropriate next step in management?

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Correct answer: D — Insert a small-bore chest drain and continue antibiotics

Pleural fluid pH below 7.2 with turbid infected fluid indicates complicated parapneumonic effusion or empyema requiring chest tube drainage plus antibiotics. Repeated diagnostic aspiration is inadequate source control. Pulmonary embolism could cause pleuritic pain but does not explain infected pleural fluid. The teaching point is that pleural pH is a management test, not a descriptive extra.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-78-1