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       Continued negative blood cultures, normal white blood count and an afebrile state are all useful in delaying lead replacement. However, they may remain normal while the patient is on a prolonged course of antibiotics. In the presence of an infected intracardiac foreign body relapses are known to occur within a few weeks of discontinuing the antibiotic. Gallium scans, spiral CT scans and a decreasing sedimentation rate are not as useful as a TEE in evaluating patients with an intracardiac mass or thrombus. The patient's TEE images are shown below. Please note the pristine appearance of both the atrial and ventricular pacer leads that are extremely well visualized. Also, there are no vegetations or thrombus attached to the tricuspid valve.

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