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21st February 2025
A 59-year-old man presents to A&E overnight with a 10-week history of productive cough and malaise.
A 59-year-old man presents to A&E overnight with a 10-week history of productive cough and malaise. His temperature is 37.7°C, heart rate 92 bpm, blood pressure 110/79 mmHg, oxygen saturations 90% on room air and respiratory rate 22/minute. Intravenous antibiotics and fluids are initiated in A&E. A diagnostic tap of the effusion is carried out and the pleural fluid analysis and blood test results are detailed below:
| Pleural fluid | Serum |
| Colour: clear Pleural total protein: 40 g/L pH: 7.1 White cell count: 30,000/mm³ (<1000/mm³) Glucose: 3.2 mmol/L LDH: 435 U/L |
White cell count: 14.5 x10⁹/L (3.6-11.0 x10⁹/L) CRP: 94 mg/L (<5 mg/L) Glucose: 6.1 mmol/L (4-11 mmol/L) LDH: 470 U/L (240-480 U/L) Total protein: 61 g/L (60-78 g/L) |
What is the most appropriate next step in management?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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