Correct!
5. Infective endocarditis with septic pulmonary embolization
The patient’s clinical presentation is consistent with the diagnosis of pulmonary septic emboli due to infective endocarditis, and the positive blood cultures and positive echocardiographic findings confirm this diagnosis. The poorly defined, peripheral, nodular opacities, some cavitary, randomly distributed throughout the lungs, are consistent with a hematogenously disseminated process, also characteristic of septic emboli. Additionally, the rapid growth of the opacities over a short time period is also typical of this diagnosis. The available data are congruent and sufficient to allow definitive management without the need for an invasive tissue diagnosis. Community-acquired pneumonia can be caused by Staphylococcus aureus, but that process is usually an airway-centered one, leading to bronchopneumonia or lobar pneumonia patterns, cavitary pneumonia, or pulmonary abscesses on chest radiography. The imaging findings are also not consistent with Pneumocystis jiroveci infection- this infection usually appears as multifocal ground-glass opacity in severely immunocompromised patients, not as multiple nodules, some with cavitation. Coccidioidomycosis infection can result in pulmonary nodules and cavities, but the patient’s clinical information and blood culture results indicate that infective endocarditis with septic pulmonary embolization is by far the more likely diagnosis.)
Diagnosis: Infective endocarditis with septic pulmonary embolization.
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