An 83-Year-Old Man Comes to the Emergency Department Due to a 1-Week

An 83-year-old man comes to the emergency department due to a 1-week history of fever, malaise, cough, right-sided chest pain, and worsening dyspnea.  Temperature is 38.4 C (101.1 F) , blood pressure is 116/70 mm Hg, and pulse is 98/min.  On physical examination, the patient is frail appearing.  Breath sounds are decreased on the right side.  Heart sounds are normal.  The abdomen is soft and nontender.  Chest x-ray shows a moderate-sized right pleural effusion.  Thoracentesis yields purulent fluid.  Pleural fluid analysis reveals a large number of leukocytes with 80% neutrophils.  Which of the following is the most likely underlying mechanism for this patient's pleural effusion?

A) Bacterial translocation from alveoli into pleural space
B) Contiguous spread from a mediastinal focus
C) Direct inoculation into the pleural space
D) Hematogenous dissemination of a distant infection
E) Reactivation of a dormant infection

Correct Answer:

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