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Pleural infection — SCE Respiratory MCQ

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HardPleural DiseasePleural infectionSCE Respiratory

A 64-year-old man with pneumonia has persistent fever and a moderate loculated pleural effusion. Pleural fluid is turbid with pH 7.08, glucose 1.8 mmol/L and LDH 1600 IU/L; Gram stain is negative. What is the most appropriate management?

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Correct answer: A — Insert a small-bore intercostal drain with antibiotics

Low pleural pH, low glucose and loculation indicate complicated parapneumonic effusion requiring drainage plus antibiotics. Negative Gram stain does not exclude pleural infection. Diuretics, observation and discharge would risk progression to organised empyema; pleurodesis is not treatment for acute infection.

Reference: BTS Pleural Disease Guideline 2023; NICE NG250