J Cardiovasc Ultrasound.  2009 Mar;17(1):19-21. 10.4250/jcu.2009.17.1.19.

Acute Pulmonary Embolism Caused by Subacute Infective Endocarditis of the Tricuspid Valve

• Park JH
• Yoo SJ
• Kang SK
• Lee JH
• Choi SW
• Jeong JO
• Seong IW

• KMID: 1473764
• DOI: http://doi.org/10.4250/jcu.2009.17.1.19

Abstract

Acute pulmonary embolism is usually caused by deep vein thrombosis of the lower extremities. However, vegetations of the tricuspid valve (TV) can cause embolic occlusion of the pulmonary vasculature and hence pulmonary embolism. We experienced a case of acute pulmonary embolism caused by subacute infective endocarditis of the TV. The computerized tomographic scans showed huge vegetations on the patient's TV and obstruction of the bilateral pulmonary arteries. He was successfully treated with intravenous antibiotics and TV replacement.

Keyword

Acute pulmonary embolism; Subacute infective endocarditis; Tricuspid valve

MeSH Terms

Anti-Bacterial Agents
Endocarditis
Lower Extremity
Pulmonary Artery
Pulmonary Embolism
Tricuspid Valve
Venous Thrombosis
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Echocardiographic examination at admission showed right ventricular dilatation and systolic dysfunction (A: End-diastole. B: End-systole). About 28×19 mm sized masses was noted on the TV (C). The measured maximal tricuspid regurgitation velocity was 3.9 m/s (estimated systolic pulmonary arterial pressure was 71 mmHg) suggesting severe resting pulmonary hypertension (D).

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  Fig. 2 Spiral computerized tomography of the chest demonstrating multifocal intraluminal filling defects (arrows) with cavitary nodules adjacent to the segmental branches of the pulmonary arteries associated with proximal vascular dilatation. There were many nodular lesions suggesting septic pneumonia (arrowhead).

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