case_images: PMC9716447_01
case_images: Axial diffusion weighted imaging (DWI) demonstrated multiple punctate, T2
  hyperintense foci within the centrum semiovale bilaterally, as well as the
  subcortical white matter of the right frontal lobe. Corresponding
  hypointense foci on apparent diffusion coefficient mapping (ADC, not shown)
  confirmed restricted diffusion. In the context of the patient's known
  endocarditis, these findings were concerning for septic emboli. (a) PSAX
  view of aortic valve with what would be classically called moderate
  paravalvular regurgitation (10-20% of circumference), (b) apical two-chamber
  view of oscillating mitral valve mass, (c) apical four-chamber view showing
  mobile mass on mitral valve with mitral annular calcification, and (d) two
  distinct paravalvular regurgitant jets on apical windows.
case_images: 10.1177_20499361221138459-fig1.jpg
case_images: PMC9716447_01_10.1177_20499361221138459-fig1.jpg
case_images: fig1-20499361221138459
case_images: With the previous prolonged positivity of blood cultures and current suspicion for prolonged bacteremia in the absence of continued antibiotic therapy, transthoracic echocardiography (TTE) was sought and demonstrated a large mobile mass on the mitral valve and moderate-severe paravalvular prosthetic aortic regurgitation, both of which were concerning for infective endocarditis in context of persistent bacteremia (Figure 1).
case_images: Axial gradient recall echo (GRE) imaging demonstrated multiple punctate foci
  of magnetic susceptibility consistent with microhemorrhages, likely
  reflecting additional sequela of small emboli.
case_images: 10.1177_20499361221138459-fig2.jpg
case_images: PMC9716447_01_10.1177_20499361221138459-fig2.jpg
case_images: fig2-20499361221138459
case_images: CT of the brain or head demonstrated an evolving, subacute right posterior cerebral artery territory infarction and follow-up magnetic resonance imaging of the brain found multiple small foci of restricted diffusion suggestive of emboli (Figure 2).