https://orcid.org/0000-0003-1310-643X
A 34-year-old female with a history of illicit drug use was admitted for recurrent methicillin-resistant Staphylococcus aureus bacteraemia. Transthoracic echocardiogram showed moderate tricuspid regurgitation (TR) with multiple vegetations attached to the tricuspid valve (TV) leaflets (Panels A and B). She was started on appropriate antibiotics. Transesophageal echocardiogram (TEE) redemonstrated moderate TR and large 40 × 20 mm posterior leaflet mobile TV vegetation, with smaller septal leaflet vegetation (Panels C and D,Supplementary data online, Video S1). She developed acute hypoxia necessitating a computed tomography angiogram of the chest which showed an occlusive right pulmonary artery (RPA) embolus. Anticoagulation was initiated, and she underwent partial catheter-directed thrombectomy. Surgical treatment was delayed allowing for stabilization of her respiratory status. A repeat TEE 4 weeks later revealed smaller vegetations on the TV leaflets with associated severe TR (Panels E and F,Supplementary data online, Video S2). It also demonstrated an occlusive RPA thrombus on a mid and upper oesophageal short-axis views at the level of ascending aorta at a 40-degree Omniplane angle (Panels G, H, I, and J,Supplementary data online, Videos S3, S4, and S5). She underwent TV replacement and RPA surgical embolectomy. Pathology of TV and RPA specimens showed fibrin tissue and inflammatory cells, confirming the tissue to be embolized vegetation. This case illustrates the use of TEE to simultaneously evaluate TV infective endocarditis (IE) and its possible complication of embolization to the pulmonary arteries. Visualization of the pulmonary artery and its branches during TEE may help to avoid missing concurrent embolization of vegetation from the TV IE.
Supplementary data are available at European Heart Journal—Cardiovascular Imaging online.
Author notes
Conflict of interest: None declared.
