UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Ali Farzad

Posted: 3/17/2014 by Haney Mallemat, MD
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Question

62 year-old male presents with weakness, chills, cough, and malaise. Recently, he had four teeth extracted but felt fine immediately after the extraction. Past medical history includes diabetes and hypertension; CXR is below. What’s the diagnosis?

Answer

Answer: Septic pulmonary emboli (a.k.a. pulmonary puffballs); he was eventually diagnosed with bacterial endocarditis.

This history with the presence of "puffballs" on CXR, should clue the practitioner to the diagnosis of septic pulmonary emboli secondary to endocarditis
CT of the chest will confirm the diagnosis and possibly demonstrate cavitary lesions.
Blood cultures should be promptly obtained and the patient should be started on broad-spectrum antibiotics.

References

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