case_images: PMC11250082_01
case_images: Transthoracic echocardiogram showing the aortic valve vegetation.
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case_images: F1
case_images: Echocardiogram showed a mildly reduced left ventricular ejection fraction of 40-45% and a mobile aortic valve echodensity (12 mm x 4 mm) seen on the non-coronary cusp suspicious for vegetation, with mild valvular regurgitation (Fig. 1).
case_images: TEE showing the aortic valve vegetation.
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case_images: F2
case_images: A transesophageal echocardiogram (TEE) was ordered to better characterize the aortic valve vegetation (Fig. 2).
case_images: Coronal view of PET CT scan showing hypermetabolic activity in the right adrenal gland.
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case_images: F3
case_images: A PET scan later performed showed no signs of a primary malignancy (Fig. 3, 4).
case_images: Transverse view of PET CT showing hypermetabolic activity in the peritoneum.
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case_images: F4
case_images: A PET scan later performed showed no signs of a primary malignancy (Fig. 3, 4).
case_images: MRI brain showing multiple strokes, likely of embolic origin.
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case_images: F5
case_images: The neurology-stroke team was consulted and agreed that the patient's prior strokes were likely thromboembolic in nature from the aortic valve with primary differential being infectious or neoplastic process. The infectious diseases team concurred that the patient's brain MRI with and without contrast findings (Fig. 5, 6), along with strokes and splenic infarct were most likely caused by a marantic, noninfectious endocarditis.
case_images: MRI brain obtained 2 months after initial MRI showing worsening of stroke burden.
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case_images: F6
case_images: The neurology-stroke team was consulted and agreed that the patient's prior strokes were likely thromboembolic in nature from the aortic valve with primary differential being infectious or neoplastic process. The infectious diseases team concurred that the patient's brain MRI with and without contrast findings (Fig. 5, 6), along with strokes and splenic infarct were most likely caused by a marantic, noninfectious endocarditis.
case_images: Timeline of patient's clinical course from first CVA to first follow-up re-staging scans after osimertinib treatment.
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case_images: F7
case_images: A timeline demonstrates the sequence of clinical events (Fig. 7).