11th January 2024

An 18-year-old cystic fibrosis patient presents to respiratory clinic for their 6-monthly review.

An 18-year-old cystic fibrosis patient presents to respiratory clinic for their 6-monthly review. They have been well with no episodes of pneumonia for the last 6 months and remain on prophylactic tobramycin via an inhaled device. A chest x-ray is completed as part of routine monitoring, which reveals a moderate-sized right-sided pleural effusion with chronic bronchiectic changes. A diagnostic aspiration is completed in clinic, and results are now available. 

Investigations: 

Pleural fluid appearance: Straw-coloured.

Pleural fluid pH: pH 7.53 

Pleural fluid protein 37g/L 

Pleural fluid LDH 178 units/L 

Pleural fluid M, C + S – Negative gram stain, culture pending. 

What is the most appropriate management strategy for this pleural effusion? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.