Correct!
1. Blood cultures
18FFDG-PET scanning will not contribute to management in this patient. Increased tracer utilization within the pulmonary opacities would suggest an active infectious or neoplastic process, but the patient’s presentation and interval development of these opacities already indicates such. Lack of tracer utilization would be a difficult to interpret finding, but likely would not alter the next steps that must be undertaken for this patient. Obtaining a tissue diagnosis, through bronchoscopy with bronchoalveolar lavage, percutaneous transthoracic fine needle aspiration biopsy, or surgical lung biopsy may provide an answer as regards the etiology of the nodules in this patient, but such procedures are premature at this point. A working diagnosis based on clinical information, the imaging appearance of the opacities and their evolution, and a few simple steps, including the performance of blood cultures, may be generated and allow provide a direction for management.
The patient’s blood cultures were positive for Staphylococcus aureus. Transthoracic echocardiography was performed and showed a vegetation on the tricuspid valve.
What is the likely diagnosis?