case_images: PMC8683236_01
case_images: AP chest radiograph on initial presentation demonstrating a wedge like consolidation in the right-lower-lobe delineated by yellow arrows.
case_images: CRIEM2021-9918420.001.jpg
case_images: PMC8683236_01_CRIEM2021-9918420.001.jpg
case_images: fig1
case_images: A chest radiograph was obtained (Figure 1) and was interpreted by the radiologist as demonstrating "bilateral patchy atelectasis":however, the emergency physicians felt it demonstrated a pleural-based wedge-like consolidation in the right inferior lobe consistent with Hampton's Hump.
case_images: (a, b) Representative images from the bedside echocardiogram (apical four-chamber view) demonstrating tricuspid vegetations (circle). (c, d) Representative images from the CT angiogram (coronal and axial images, respectively) revealing the right-lower-lobe wedge infarct.
case_images: CRIEM2021-9918420.002.jpg
case_images: PMC8683236_01_CRIEM2021-9918420.002.jpg
case_images: fig2
case_images: A limited bedside transthoracic echocardiogram (Figures 2(a) and 2(b)) in the ED revealed findings concerning for tricuspid valve vegetations as well as a slightly enlarged right ventricle without any D-sign (i.e., a D-shaped left ventricle on parasternal short-axis view, consistent with right ventricular strain causing shift of the ventricular septum). The CTA revealed findings consistent with multiple septic emboli and mycotic aneurysms (Figures 2(c) and 2(d)), as well as multiple segmental pulmonary arterial occlusions with associated infarcts or hemorrhage.