A 65-year-old female presents with a history of fever
with chills, breathlessness and swelling of her ankles of several weeks
She is a non insulin dependent diabetic well controlled
on gliclazide and metformin.
On examination she is febrile, pulse 100 beats per
minute, BP 130/90 JVP not elevated, heart sounds normal with a soft systolic
murmur at the apex.
Trachea was deviated to the left, there was reduced
respiratory movement, decreased vocal fremitus, stony dull percussion note and
absent breath sounds with diminished vocal resonance at the right base.
Hb 10 .0 g/dL
MCV 90 fl
WBC 11.7 x 109 / L (90% neutrophils)
Platelets 500 x 109 / L
ESR 80 mm in 1st hour
Albumin 20 g/L
Bilirubin 15 mmols/L
ALT 30 U/L
Alkaline phosphatase 160 U/L
Chest X-ray showed a right pleural effusion
Blood culture Streptococcus milleri isolated
In this patient which one of the following is likely to
give you a definite diagnosis?