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2009 Oct 23 – What is your next step?

A 50-year old lady was admitted because of fever and shortness of breath. A CXR was taken. After starting treatment for pneumonia, what specific investigation would you consider next? 

Figure. Chest radiograph of the patient (Photo courtesy of ICU, PYNEH, Hong Kong)
A. Spiral CT to rule out pulmonary embolism
B. Echocardiogram to rule out chronic rheumatic heart disease
C. Bronchoscopy to rule out atypical infections 
D. No need for further investigation