Rapidly progressive pleural effusion January 2019

TO THE EDITOR: Regarding the article about a man with rapidly progressive pleural effusion by Zoumot et al in the January 2019 issue,¹ there was some inconsistency between the teaching points and the actions taken.

Question 1 asked what was the most likely cause of the patient’s pleuritic chest pain. Pulmonary embolism was an unlikely diagnosis, given the patient’s presentation and his normal D-dimer level, which the text acknowledges, but then proceeds to state that computed tomographic angiography of the chest was done anyway.

After pleural effusion was diagnosed, question 2 asked what was the best management strategy for the patient at that time. The best management strategy was to give oral antibiotics with close follow-up because the patient was at low risk of a poor outcome, but he was advised to be admitted for intravenous antibiotics anyway.

I’m not quite sure of the point of the didactic exercise when actions are not consistent with the analytic rationale for testing and treatment.

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