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Undiagnosed exudative pleural effusion — SCE Respiratory MCQ

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ModeratePleural DiseaseUndiagnosed exudative pleural effusionSCE Respiratory

A 66-year-old woman has an unexplained unilateral exudative pleural effusion. CT shows pleural nodularity but no lung mass. Pleural fluid cytology is negative and she is clinically stable. What is the most appropriate investigation?

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Correct answer: C — Image-guided pleural biopsy or thoracoscopy

Unilateral exudative effusion with pleural nodularity and negative cytology requires pleural tissue, obtained by image-guided biopsy or thoracoscopy. Repeating cytology alone delays diagnosis when pleural malignancy is likely. Spirometry, D-dimer and diuretics do not explain or investigate nodular pleural disease adequately.

Reference: BTS Pleural Disease Guideline 2023