J Cardiovasc Ultrasound.  2014 Jun;22(2):91-94. 10.4250/jcu.2014.22.2.91.

Streptococcus Constellatus Community Acquired Pneumonia with Subsequent Isolated Pulmonic Valve Endocarditis and Abscess Formation in a Structurally Normal Heart

  • 1Department of Cardiac Sciences, Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada. tarek.elhussein@albertahealthservices.ca


Pulmonic valve infective endocarditis in isolation is a rare clinical entity. The formation of an abscess in the right ventricular outflow tract as a consequence of vegetations affecting the pulmonic valve in a structurally normal heart is extremely rare and has not been reported. We report a case of isolated pulmonic valve endocarditis complicated by a regional abscess formed within the right ventricular outflow tract caused by Streptococcus Constellatus (S. Constellatus), a member of the Streptococcus Milleri group in a young male whose risk factor was alcohol abuse and he was treated medically, a comprehensive literature review on the subject is also reported. Our case is the first reported in literature with infective endocarditis caused by S. Constellatus affecting the pulmonic valve, and the first with pulmonic valve endocarditis and perivalvular abscess formation in a structurally normal heart.


Infective endocarditis; Pulmonary valve; Echocardiogram; Streptococcus

MeSH Terms

Pulmonary Valve
Risk Factors
Streptococcus constellatus*
Streptococcus milleri Group


  • Fig. 1 Transthoracic echocardiogram. Left parasternal short axis view at the level of the aortic valve showing (arrow) large sized vegetation attached to the pulmonic valve.

  • Fig. 2 Transoesophageal echocardiogram. Mid-oesophageal short axis view at the level of the aortic valve showing (arrow) large sized vegetation attached to the right ventricular outflow tract side of the pulmonic valve. A: tricuspid valve appears normal in structure.

  • Fig. 3 Transoesophageal echocardiogram. Mid-oesophageal right ventricular outflow view showing large sized vegetations attached to the right ventricular outflow tract (RVOT) side of the pulmonic valve (solid arrow). An abscess within the posterior wall of the RVOT, note the echo free spaces within (open arrow).

  • Fig. 4 Transthoracic echocardiogram. Left parasternal right ventricular outflow tract (RVOT) view showing moderate sized chronic healed vegetation attached to the pulmonic valve. No abscess is identified in the RVOT (arrow).


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