(C) is not the one that we were looking for! (A) is correct!
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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