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 BOF 42

 

   

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BOF: 42

A 65-year-old female presents with a history of fever with chills, breathlessness and swelling of her ankles of several weeks duration.

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.

Investigations

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?

a)      Transthoracic ECHO

b)      Transoesophageal ECHO

c)      Bronchoscopy

d)      Colonoscopy

e)      Ultrasound abdomen

 

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