22nd May 2024

A 56-year-old with established COPD presents with a 2-week history of increasing shortness of breath

A 56-year-old with established COPD presents with a 2-week history of increasing shortness of breath, pyrexia, and feeling generally unwell. She complains of right sided chest pain, a productive cough and shortness of breath. She has not been able to go to work for the last week and took a course of amoxicillin and prednisolone from her GP with no effect. She completed this course 6 days ago. She denies any history of trauma. Her RR is 21, saturations are 96% on air, HR is 71 bpm, BP is 155/88 mHg. Her CRP and WCC are raised, as was her D-dimer, which prompted the emergency department to perform a CTPA. This showed fluid at the base of the right lung with effacement of the pleura, as well as lobar collapse in the right lower zone. It did not demonstrate a PE. She has no allergies.

Which of the following is correct regarding this patient’s diagnosis and management?

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