skip to main content

Loculated pleural infection — SCE Respiratory MCQ

Instant feedback + full explanation. One question, done properly.

HardPleural DiseaseLoculated pleural infectionSCE Respiratory

A 42-year-old man has pneumonia complicated by a loculated pleural collection. A 12F drain is inserted and appropriate antibiotics are given. After 48 hours he remains febrile, ultrasound shows persistent septated fluid and drain output is minimal despite correct position. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: B — Intrapleural tissue plasminogen activator plus DNase

Persistent loculated pleural infection with poor drainage despite a correctly positioned drain is an indication to consider intrapleural tPA plus DNase. Oral antibiotics alone are unlikely to provide source control. Cytology and diuretics do not treat septated infected pleural fluid.

Reference: BTS Pleural Disease Guideline 2023; MIST2 evidence: https://www.brit-thoracic.org.uk/clinical-resources/guidelines/pleural-disease/