Correct!
4. 1 and 3

Bloody pleural effusions are often due to malignancy (1). They can also be seen with pulmonary embolism with infarction (1). These are uncommon and are usually large pulmonary emboli. Traumatic thoracentesis can result in blood-tinged fluid but would be very unlikely to result in a grossly bloody aspiration.

Which of the following would be the next diagnostic step(s)? (Click on the correct answer to proceed to the fourth of six panels)

1. Blind pleural biopsy
2. Coccidioidomycosis serology
3. Video-assisted thorascopic surgery (VATS)
4. 1 and 3
5. All of the above

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