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Loculated pleural infection — SCE Respiratory MCQ

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ModeratePleural DiseaseLoculated pleural infectionSCE Respiratory

A 44-year-old man presents with fever, pleuritic pain and a pleural collection. Drainage yields pus; after 48 hours of antibiotics and a patent drain, ultrasound shows persistent septated collection and sepsis continues. What is the most appropriate management?

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Correct answer: E — Intrapleural alteplase and DNase

Persistent sepsis with a septated pleural infection despite antibiotics and drainage is an indication to consider intrapleural tPA/DNase. Pleurodesis is contraindicated in active infection. Removing the drain or switching to oral therapy alone would fail to control the infected pleural space.

Reference: BTS Pleural Disease Guideline 2023; MIST2 evidence