case_images: PMC9997473_01
case_images: (a) Chest CT showing multiple peripherally based nodules (b) TEE showing a 1 x 0.9 cm vegetation in the TV
case_images: ACA-26-105-g001.jpg
case_images: PMC9997473_01_ACA-26-105-g001.jpg
case_images: F1
case_images: A Computer topography (CT) of the chest exhibited multiple peripherally based nodules on both lungs, some with cavitation suggestive of septic emboli [Figure 1a]. He was started on empiric antibiotic therapy and a transesophageal echocardiography (TEE) was performed, revealing a 1 x 0.9 cm mobile vegetation in the TV [Figure 1b].
case_images: PMC9997473_02
case_images: (a) Chest CT showing multifocal ground glass opacities with internal cavitation (b) TEE showing a 1.5 x 1.1 cm vegetation on the TV
case_images: ACA-26-105-g002.jpg
case_images: PMC9997473_02_ACA-26-105-g002.jpg
case_images: F2
case_images: A CT of the chest was obtained that showed multifocal ground-glass and nodular opacities with internal cavitation in a peripherally predominant distribution concerning for septic emboli [Figure 2a]. An initial transthoracic echocardiography was unremarkable, but a follow up TEE revealed moderate-to-severe tricuspid regurgitation along with a 1.5 x 1.1 cm vegetation on the TV [Figure 2b].
case_images: PMC9997473_03
case_images: (a) Chest CT showing multifocal nodular opacities with a complex loculated pleural effusion (b) TEE showing a 1m x 1.5 cm vegetation on the TV
case_images: ACA-26-105-g003.jpg
case_images: PMC9997473_03_ACA-26-105-g003.jpg
case_images: F3
case_images: A CT of the chest was performed that exhibited multifocal nodular and consolidative opacities, some with central cavitation, and a complex loculated pleural effusion on the right pleura [Figure 3a]. TEE was performed that showed a 1 x 1.5 cm vegetation on the TV with moderate tricuspid regurgitation [Figure 3b]. The patient's blood results returned positive for methicillin-resistant S. aureus for two out of two.