A 64-Year-Old Man with a Moderate Right-Sided Pleural Effusion Seen

A 64-year-old man with a moderate right-sided pleural effusion seen on initial chest x-ray was admitted for pneumonia.  Initial admission testing showed a white blood cell count of 14,800/mm³ with 92% neutrophils.  He was started on ceftriaxone and azithromycin, and his symptoms improved over the next few hours.  The patient's other medical problems include hypertension, hyperlipidemia, and hypothyroidism.  He is a former smoker with a 25-pack-year history.
His blood pressure this morning is 142/90 mm Hg, pulse is 88/min, and respirations are 16/min.  Oxygen saturation is 93% on room air.  The patient speaks in full sentences, without respiratory distress.  Jugular venous pressure is estimated at 5 cm H₂O.  Lung examination shows decreased breath sounds, decreased tactile fremitus, and dullness to percussion less than halfway up the right chest.  A soft second heart sound and 3/6 systolic ejection murmur are heard at the upper right sternal border with radiation to the carotids.
The white blood cell count is 12,200/mm³ with 78% neutrophils.  A right lateral decubitus chest x-ray demonstrates a 20-mm free-flowing effusion.  Further imaging shows an effusion in the right base without pleural thickening.
Which of the following is the best next step in management of this patient?

A) Administer furosemide
B) Change antibiotics to cefepime and vancomycin
C) Insert chest tube
D) Perform diagnostic thoracentesis
E) Switch to oral antibiotics

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Sign up to view answer