A 44-year-old man with a parapneumonic effusion.

232 CMAJ, February 19, 2013, 185(3) © 2013 Canadian Medical Association or its licensors A 44-year-old man presents to his local emergency department with a 10-day history of fever, night sweats, productive cough and right-sided pleuritic chest pain. He has a history of alcohol abuse. Two weeks prior, he was assessed in the same emergency department after he was found obtunded on a park bench. He left the following day against medical advice. On examination, his temperature is 39.0°C, and his oxygen saturation is 87% on room air. He has poor dentition. Chest examination reveals dullness to percussion at the right base and bronchial breath sounds in the area of the right lower lobe. A chest radiograph shows right lower lobe consolidation and an associated para pneumonic effusion (example shown in Figure 1). What are the clinical implications of a pleural effusion with pneumonia?