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Complicated pneumonia with empyema — RACP Paediatrics MCQ

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HardRespiratoryComplicated pneumonia with empyemaRACP Paediatrics

A 6-year-old has fever and pleuritic chest pain five days after starting oral antibiotics for pneumonia. He is tachypnoeic, has reduced breath sounds at the left base and CRP is rising. Chest X-ray shows a large left pleural opacity with a meniscus. What is the most likely diagnosis?

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Correct answer: A — Parapneumonic effusion with empyema

Persistent fever, pleuritic pain, rising inflammatory markers and a meniscus-shaped pleural opacity suggest parapneumonic effusion or empyema. Uncomplicated viral pneumonia would not usually cause a large unilateral pleural collection. Ultrasound would be the next test to define septations and guide drainage decisions.

Reference: RCH Pneumonia guideline; Therapeutic Guidelines (eTG)