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Tuberculosis — RCPSC IM MCQ

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HardInfectious DiseasesTuberculosisRCPSC IM

A patient who injects drugs has methicillin-susceptible Staphylococcus aureus bacteremia, a new murmur and cavitating peripheral lung nodules. Transthoracic echocardiography is technically limited and shows no vegetation. What is the next cardiac investigation?

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Correct answer: D — Perform transesophageal echocardiography

The best answer is “Perform transesophageal echocardiography”. S. aureus bacteremia, a murmur and septic pulmonary emboli make right-sided endocarditis highly likely. A limited negative transthoracic study cannot exclude it, so transesophageal echocardiography is appropriate; stress testing, delayed assessment and coronary imaging do not define vegetations or complications.

Reference: Choosing Wisely Canada, cardiology recommendations: https://choosingwiselycanada.org/recommendation/cardiology/