A 4-year-old child admitted with right lower lobe pneumonia has persistent high fever and increasing respiratory distress despite 48 hours of intravenous amoxicillin. Chest X-ray shows a large right-sided pleural effusion with loculations. What is the most appropriate next step in management?

• A Switch to intravenous ceftriaxone
• B Ultrasound of the thorax ✓
• C CT scan of the chest
• D Blood culture and sensitivity

Explanation

Ultrasound thorax is the preferred initial imaging for complicated pneumonia with effusion. It confirms the presence of fluid, identifies loculations, and guides drainage. CT is not first-line. Changing antibiotics alone is insufficient when a drainable collection exists. Blood culture does not address the immediate need for source control.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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