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Undiagnosed unilateral pleural effusion — SCE Respiratory MCQ

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ModeratePleural DiseaseUndiagnosed unilateral pleural effusionSCE Respiratory

A 68-year-old man has a unilateral pleural effusion found after weight loss and pleuritic pain. Ultrasound-guided aspiration shows an exudate with negative Gram stain and cytology showing atypical but non-diagnostic cells. CT shows pleural nodularity. What is the most appropriate investigation?

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Correct answer: A — Image-guided pleural biopsy

Pleural nodularity and a non-diagnostic exudate require tissue diagnosis, with image-guided pleural biopsy appropriate when focal pleural abnormality is visible. Repeating radiography delays diagnosis. Diuretics are appropriate for typical transudates, not unexplained nodular exudative pleural disease.

Reference: BTS Pleural Disease Guideline 2023