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Safe pleural aspiration — SCE Respiratory MCQ

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ModeratePleural diseaseSafe pleural aspirationSCE Respiratory

A 52-year-old woman needs diagnostic aspiration of a small unilateral pleural effusion. Bedside examination is unreliable because of obesity, and a recent CT suggests only a 1.5 cm fluid depth posteriorly. She is anticoagulated with apixaban for atrial fibrillation and has normal renal function. The respiratory team is planning the safest approach. What is the most appropriate investigation?

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Correct answer: E — Thoracic ultrasound immediately before the procedure

Thoracic ultrasound should be used to confirm fluid, mark a safe site and reduce complications for pleural aspiration. Blind aspiration is unsafe when the effusion is small and landmarks are difficult. Anticoagulation planning is important, but it does not remove the need for real-time imaging assessment.

Reference: BTS Clinical Statement on Pleural Procedures; BTS Pleural Disease Guideline 2023