Rast Johnathon J, Sulaiman Zoheb, Shahbazian Kayla, Huggett Ashley
Internal Medicine, WellStar MCG Health, Augusta, USA.
Infectious Disease, WellStar MCG Health, Augusta, USA.
Cureus. 2024 Apr 17;16(4):e58477. doi: 10.7759/cureus.58477. eCollection 2024 Apr.
A 39-year-old male with a history of intravenous drug use (IVDU) and no significant cardiovascular disease was admitted to the ICU for management of septic shock and acute hypoxic respiratory failure secondary to septic pulmonary emboli. Due to a high clinical suspicion for right-sided infective endocarditis (IE), he received a transthoracic echocardiogram (TTE), which did not reveal any vegetations. However, a transesophageal echocardiogram (TEE) was subsequently performed; this showed a large 2.4 cm vegetation in the septal aspect of the tricuspid valve (TV) subvalvular apparatus. He urgently underwent surgical removal of the vegetation and repair of the TV. Postoperatively, he clinically recovered with appropriate antibiotic therapy. TEE is the ideal imaging modality in evaluation for IE, but a minimally invasive TTE is often performed first. This case highlights a highly unusual anatomic location of IE, which harbored a large vegetation undetected by TTE. In patients without cardiac devices or non-native valves, an urgent TEE remains diagnostically essential if there is a high clinical suspicion for right-sided IE, even if a TTE shows no evidence of IE.
一名39岁男性，有静脉注射毒品史（IVDU），无明显心血管疾病，因脓毒性休克和脓毒性肺栓塞继发的急性低氧性呼吸衰竭入住重症监护病房（ICU）。由于临床高度怀疑右侧感染性心内膜炎（IE），他接受了经胸超声心动图（TTE）检查，未发现任何赘生物。然而，随后进行了经食管超声心动图（TEE）检查；结果显示在三尖瓣（TV）瓣下装置的间隔侧有一个2.4厘米的大赘生物。他紧急接受了赘生物手术切除和TV修复。术后，经适当的抗生素治疗，他临床康复。TEE是评估IE的理想成像方式，但通常首先进行微创TTE。该病例突出了IE一个非常不寻常的解剖位置，TTE未检测到此处有大的赘生物。在没有心脏装置或人工瓣膜的患者中，如果临床高度怀疑右侧IE，即使TTE未显示IE证据，但紧急TEE在诊断上仍然至关重要。
