Infective endocarditis - large mobile vegetation
Pain, numbness and pale appearance of the left lower limb
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Large mobile echogenic irregular mass attached to the atrial side of the anterior mitral leaflet
Significant mitral regurgitation (Coanda effect)
Hyper-dynamic left ventricule
5 case question available
This patient presented with acute limb ischemia, however, during her cardiac evaluation, her echo study showed a large mass on the anterior mitral valve leaflet.
Her echo findings showed vegetation on the atrial side of the anterior mitral leaflet. Blood culture was positive for Staphylococcus aureus. Eventually, the patient was transferred to cardiovascular surgery due to the clinical\echocardiographic deterioration despite antimicrobial therapy.
This embolic event possibly related to the migration of vegetations, which more often to be seen with large vegetations (>10 mm).
The general approach of infective endocarditis treatment is initial clinical stabilization, early blood cultures, and medical and/or surgical treatment.
Antibiotic treatment depends on whether the involved valve is native or prosthetic, as well as on the causative microorganism and its antibiotic susceptibilities.
- 1. George Galyfos, Sotirios Giannakakis, Stavros Kerasidis, Georgios Geropapas, Georgios Kastrisios, Gerasimos Papacharalampous, and Chrisostomos Maltezos. Infective endocarditis as a rare cause for acute limb ischemia doi: 10.5847/wjem.j.1920-8642.2016.03.012
- 2. Kitts D, Bongard FS, Klein SR. Septic embolism complicating infective endocarditis. (1991) Journal of vascular surgery. 14 (4): 480-5; discussion 485-7. Pubmed
- 3. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. (2015) Circulation. 132 (15): 1435-86. doi:10.1161/CIR.0000000000000296 - Pubmed