J Cardiovasc Ultrasound.  2009 Dec;17(4):138-140. 10.4250/jcu.2009.17.4.138.

Pulmonary Valve Endocarditis with Septic Pulmonary Thromboembolism in a Patient with Ventricular Septal Defect

• Park HE
• Cho GY
• Kim HK
• Kim YJ
• Sohn DW

• KMID: 1473717
• DOI: http://doi.org/10.4250/jcu.2009.17.4.138

Abstract

We describe a 42-year-old man who presented as life-threatening sepsis and septic shock with multiple septic pulmonary embolism and septic pneumonia due to pulmonary valve endocarditis. The patient had history of untreated ventricular septal defect (VSD) and complained of severe dyspnea and orthopnea. Transthoracic and transesophageal echocardiograms revealed severe pulmonary regurgitation with large, hypermobile vegetation on pulmonary valve and right ventricular outflow tract (RVOT), and a small subarterial type VSD. Emergency operation was done due to rapid deterioration of the patient, and after 6 weeks of antibiotics coverage, he was discharged.

Keyword

Pulmonary valve; Endocarditis; Ventricular septal defect

MeSH Terms

Adult
Anti-Bacterial Agents
Dyspnea
Emergencies
Endocarditis
Heart Septal Defects, Ventricular
Humans
Pneumonia
Pulmonary Embolism
Pulmonary Valve
Pulmonary Valve Insufficiency
Sepsis
Shock, Septic
Anti-Bacterial Agents

Figure

• 

  Fig. 1 A: Transthoracic parasternal short axis view showing large, mobile vegetation (white arrow) on pulmonary valve. B: Transesophageal echocardiography showing a small subarterial type VSD with left to right shunt. Large amount of thrombus and vegetation were found in right ventricle. MPA: main pulmonary artery, LVOT: left ventricular outflow tract, Ao: aorta.

• 

  Fig. 2 Initial chest CT showing (A) pulmonary embolism (white arrows) and (B) destructed pulmonary valve (white arrows). Lung parenchyme on CT shows diffuse grass ground opacity with multifocal patchy and nodular consolidations at both lungs suggesting combined septic pneumonia.

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