Cardiovascular Pathology - Case 8 - Part 2
   

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 Over the next two days a work up was carried out to find the source and etiology for the embolic events. A trans-esophageal echocardiogram (TEE) was performed that revealed vegetations on the mitral valve. Cultures were taken and a mitral valve replacement was performed by thoracic surgery. During surgery lymph nodes were noted in the mediastinum and a biopsy was performed but this only contained thymic tissue on frozen section. The valve was replaced.

List of microbiology tests done, all were negative:

04/06/03 10:00

TISSUE, MITRAL VALVE

FUNGAL SMEAR-CALCOFLUOR WHITE,

04/06/03 10:00

TISSUE, MITRAL VALVE

CHLAMYDIA CULTURE,

04/06/03 10:00

TISSUE , MITRAL VALVE

UREAPLASMA-MYCOPLASMA CULTURE,

04/06/03 10:00

TISSUE, MITRAL VALVE

LEGIONELLA CULTURE,

04/06/03 10:00

HEART, MITRAL VALVE

ANAEROBE CULTURE,

04/06/03 10:00

TISSUE , MITRAL VALVE

TISSUE CULTURE,

04/06/03 10:00

HEART, MITRAL VALVE

BARTONELLA CULTURE,

04/06/03 10:00

TISSUE , MITRAL VALVE

MYCOPLASMA PNEUMONIAE CULTURE,

04/06/03 10:00

HEART, MITRAL VALVE

FUNGAL CULTURE,

04/06/03 10:00

HEART, MITRAL VALVE

AFB CULTURE,

04/05/03 19:15

BLOOD, LEFT HAND

BLOOD CULTURE, BOTTLE SYSTEM,

04/05/03 19:01

BLOOD, LEFT WRIST

BLOOD CULTURE, BOTTLE SYSTEM,

04/05/03 18:15

BLOOD, ANTECUBITAL

FUNGAL CULTURE, BLOOD,

04/05/03 17:45

BLOOD, ANTECUBITAL

BARTONELLA CULTURE,

04/05/03 16:33

BLOOD, LEFT FOREARM

FUNGAL CULTURE,

04/04/03 18:42

BIOPSY, PUNCH

TISSUE CULTURE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE,

RESPIRATORY VIRUSES DFA,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE

ANAEROBE CULTURE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE

LEGIONELLA PNEUMOPHILA DFA,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE

FUNGAL SMEAR-CALCOFLUOR WHITE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE

RESPIRATORY CULTURE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE,

HSV CULTURE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE

LEGIONELLA CULTURE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE,

VIRAL CULTURE with CMV CULTURE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE

FUNGAL CULTURE,

04/04/03 13:40

BRONCHIAL ALVEOLAR LAVAGE

AFB CULTURE,

1. Should there have been follow up to the frozen section report of the mediastinal biopsy?

2. What is your differential diagnosis now?