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Lymphangioleiomyomatosis — SCE Respiratory MCQ

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HardILDLymphangioleiomyomatosisSCE Respiratory

A lymphocytic unilateral exudate is strongly suspected to represent pleural tuberculosis. Pleural-fluid smear and culture are negative and the patient is stable enough for further sampling. Which diagnostic step best supports organism recovery and susceptibility testing?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Obtain image-guided or thoracoscopic pleural tissue for mycobacterial culture and histology

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

C is correct. BTS advises pleural tissue sampling for culture and sensitivity in all patients with suspected tuberculous pleural effusion because fluid is paucibacillary and tissue improves microbiological and histological yield. ADA or interferon-gamma can support diagnosis in high-prevalence settings and low ADA may help exclude disease in low-prevalence settings, but biomarkers do not provide susceptibility. IGRA identifies sensitisation rather than active pleural infection, cytology cannot replace culture, and corticosteroid monotherapy risks untreated active TB.

Reference: https://thorax.bmj.com/content/78/Suppl_3/s1