Infective endocarditis - large mobile vegetation

Case contributed by Allam Harfoush

Presentation

Pain, numbness and pale appearance of the left lower limb

Patient Data

Age: 60 years
Gender: Female

Large mobile echogenic irregular mass attached to the atrial side of the anterior mitral leaflet

Significant mitral regurgitation (Coanda effect)

Aortic regurgitation 

Hyper-dynamic left ventricule

Case Discussion

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.

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Case information

rID: 76230
Published: 27th Apr 2020
Last edited: 29th Apr 2020
System: Cardiac
Inclusion in quiz mode: Included
Institution: Tishreen University Hospital

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