Split pleura sign — SCE Respiratory MCQ

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HardImagingSplit pleura signSCE Respiratory

A 60-year-old man with pneumonia has persistent fever and pleuritic pain despite antibiotics. Contrast CT shows enhancing visceral and parietal pleura separated by lenticular pleural fluid. Ultrasound shows septations and aspiration yields turbid fluid with pH 7.05. He is not shocked. What is the most likely diagnosis?

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Correct answer: B — Empyema

The best answer is “Empyema”. The clinical pattern, physiology and imaging described are most consistent with Empyema. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Uncomplicated parapneumonic effusion”, “Malignant pleural effusion”, “Chylothorax, after safety review”, “Pleural lipoma, after specialist assessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1