Presentation
Intravenous drug user with history of spinal staphylococc osteomyelitis, now with shortness of breath and a new murmur.
Patient Data
Vegetation arising from the ventricular side of the non-coronary cusp of the aortic valve. Small bilateral pleural effusions and atelectasis adjacent lung. Otherewise normal, no obstructive coronary artery disease.
Case Discussion
In a patient with a history of intravenous drug use who presents with positive blood cultures and a new murmur, the most likely reason for a valvular lesion is a vegetation due to infective endocarditis. Vegetations are usually found on the lower pressure side of the valve: in the case of the aortic valve, the left ventricle is the lower pressure side. Damage to the valve leaflets results in insufficiency, although on occasion, a large vegetation may obstruct the valve and cause stenosis.
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