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Loculated pleural infection — SCE Respiratory MCQ

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HardPleural DiseaseLoculated pleural infectionSCE Respiratory

A patient with pleural infection has a correctly positioned drain but persistent locules. Pleural-fluid pH is 7.05 and CT shows a thick pleural rind. Which finding most directly predicts failure of simple aspiration alone?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Loculation with low pleural pH

Low pleural pH and loculation indicate a complicated parapneumonic effusion requiring effective drainage rather than aspiration alone. Persistent collection after drainage prompts consideration of tPA–DNase or surgery according to fitness and response.

Reference: BTS Pleural Disease Guideline 2023. https://www.brit-thoracic.org.uk/clinical-resources/guidelines/pleural-disease/