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Post-cardiac injury syndrome — SCE Respiratory MCQ

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HardPleural DiseasePost-cardiac injury syndromeSCE Respiratory

A 67-year-old man has a right pleural effusion after coronary artery bypass grafting 5 weeks ago. He has low-grade fever and pleuritic pain. Pleural fluid is an exudate with lymphocyte predominance, pH 7.38 and negative cultures; CT shows no pleural nodularity. What is the most likely diagnosis?

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Correct answer: E — Post-cardiac injury syndrome pleuritis

A delayed lymphocytic exudative effusion with pleuritic symptoms after cardiac surgery fits post-cardiac injury syndrome. Empyema would usually have low pH, neutrophilia or positive microbiology, and chylothorax would be milky with high triglycerides. Heart failure usually causes a transudate, while mesothelioma would be suggested by nodular pleural thickening and exposure history.

Reference: BTS Pleural Disease Guideline 2023