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Pleural infection — SCE Respiratory MCQ

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HardPleural diseasePleural infectionSCE Respiratory

A 56-year-old man is admitted with pneumonia and persistent fever after 48 hours of antibiotics. Ultrasound shows a complex septated pleural effusion and pleural aspiration yields cloudy fluid. Pleural pH is 7.12, glucose is 2.1 mmol/L, LDH is 1,800 IU/L and Gram stain shows Gram-positive cocci. He is breathless but haemodynamically stable. What is the most appropriate management?

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Correct answer: A — Prompt small-bore chest tube drainage plus antibiotics

Low pleural pH, low glucose, high LDH and organisms indicate pleural infection requiring chest tube drainage as well as antibiotics. Antibiotics alone are inadequate when biochemical and microbiological criteria indicate complicated parapneumonic effusion or empyema. Ultrasound helps guide safe drain placement and identify septations.

Reference: BTS Pleural Disease Guideline 2023; BTS CAP Guideline