case_images: PMC6590612_01
case_images: Right first toe with Janeway lesion (vascular emboli phenomena).
case_images: CRIC2019-5496851.001.jpg
case_images: PMC6590612_01_CRIC2019-5496851.001.jpg
case_images: fig1
case_images: On exam, he had significant bibasilar crackles as well as a holosystolic apical murmur; additionally, he was found to have 2+ lower extremity edema and several punctuate macular lesions on his feet, highly suspicious for vascular emboli phenomena (Figure 1).
case_images: Arrowhead: TTE showing a mobile mass on the posterior leaflet of the mitral valve consistent with a vegetation.
case_images: CRIC2019-5496851.002.jpg
case_images: PMC6590612_01_CRIC2019-5496851.002.jpg
case_images: fig2
case_images: Ejection fraction was calculated to be 40% (Figure 2).
case_images: (a) TEE image of vegetation on posterior leaflet of mitral valve, measuring "1.42 cm x 2.52 cm" (arrowhead). (b) TEE image with evidence of blood flow regurgitation with Doppler into the left atrium in the setting of the mitral valve posterior leaflet vegetation.
case_images: CRIC2019-5496851.003.jpg
case_images: PMC6590612_01_CRIC2019-5496851.003.jpg
case_images: fig3
case_images: At day 5, the patient received a transesophageal echocardiogram (TEE) which confirmed a "1.4 cm x 2.5 cm" vegetation attached to the posterior leaflet of mitral valve (Figure 3(a)), with severe mitral regurgitation and posterior leaflet perforation (Figure 3(b)).