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Pleural infection — SCE Respiratory MCQ

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HardThoracic ImagingPleural infectionSCE Respiratory

A 59-year-old man with fever and pleuritic pain has CXR showing a left lower-zone opacity. Thoracic ultrasound demonstrates an anechoic pleural effusion with mobile septations. Diagnostic aspirate has pH 7.12, glucose 1.8 mmol/L, LDH 1700 IU/L and Gram stain is negative. What is the most appropriate management?

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Correct answer: E — Observe while awaiting pleural fluid culture

Pleural infection is indicated by septations and pleural fluid pH below 7.2, so prompt drainage plus antibiotics is required even if Gram stain is negative. Waiting for culture delays source control. PET-CT and diuretics do not address infected pleural fluid.

Reference: BTS Pleural Disease Guideline 2023