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Large symptomatic pleural effusion — SCE Acute Medicine MCQ

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ModerateProcedural KnowledgeLarge symptomatic pleural effusionSCE Acute Medicine

A 69-year-old woman with weight loss and progressive breathlessness has a large right pleural effusion on chest radiograph. She is stable, oxygen saturation is 95% on air and there is no fever. Ultrasound confirms a safe pocket of fluid. What is the most appropriate investigation?

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Correct answer: A — Ultrasound-guided diagnostic pleural aspiration

A new unilateral pleural effusion requires diagnostic aspiration, and ultrasound guidance reduces complications and improves success. Chest drain insertion is not first-line unless there is pleural infection, significant symptoms needing controlled drainage or pneumothorax. Bronchoscopy may follow if imaging suggests endobronchial disease but does not replace fluid analysis. The pearl is that pleural fluid cytology, biochemistry and microbiology shape the pathway.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-81-1