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Malignant pleural effusion — RCPSC IM MCQ

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ModerateRespirologyMalignant pleural effusionRCPSC IM

A 70-year-old man with weight loss and pleuritic discomfort has a unilateral large pleural effusion. Thoracentesis shows pleural protein 44 g/L, serum protein 66 g/L, pleural LDH 320 U/L and serum LDH 180 U/L. Cytology from the first sample is negative. CT chest shows pleural nodularity. What is the most appropriate investigation?

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Correct answer: D — Image-guided pleural biopsy

An exudative effusion with pleural nodularity and negative initial cytology needs tissue diagnosis, commonly image-guided pleural biopsy or thoracoscopy.

Reference: Canadian Thoracic Society pleural disease resources