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Thoracic ultrasound safety — SCE Respiratory MCQ

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HardPleural DiseaseThoracic ultrasound safetySCE Respiratory

A 63-year-old man with a large right pleural effusion is referred for aspiration. Bedside examination suggests dullness to percussion, but ultrasound shows consolidated lung with a small posterior effusion less than 1 cm deep. What is the most appropriate management?

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Correct answer: C — Do not aspirate; reassess after imaging-guided planning

The best answer is “Do not aspirate; reassess after imaging-guided planning”. Do not aspirate; reassess after imaging-guided planning is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Proceed with blind aspiration at the point of dullness”, “Insert a large-bore drain immediately”, “Perform pleurodesis in the absence of fluid sampling”, “Use percussion findings to choose the puncture site”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1