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21st February 2025
A 43-year-old man presents to A&E overnight with a 1-week history of breathlessness, cough and fevers.
A 43-year-old man presents to A&E overnight with a 1-week history of breathlessness, cough and fevers. A chest X-ray demonstrates a right middle lobe pneumonia with an associated effusion. His temperature is 38.2°C, heart rate 105 bpm, blood pressure 130/82 mmHg, oxygen saturations 91% on room air and respiratory rate 24/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: 60 g/L pH: 7.4 White cell count: 25,000/mm³ (<1000/mm³) Glucose: 5.1 mmol/L LDH: 300 U/L Gram stain: negative |
White cell count: 15.0 x10⁹/L (3.6-11.0 x10⁹/L) CRP: 150 mg/L (<5 mg/L) Glucose: 5.9 mmol/L (4-11 mmol/L) LDH: 320 U/L (240-480 U/L) Total protein: 65 g/L (60-78 g/L) |
What is the most appropriate next step in management?
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