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Case Reports
. 2022 Sep 5;6(9):ytac350.
doi: 10.1093/ehjcr/ytac350. eCollection 2022 Sep.

Infective endocarditis on interventricular communication as cause of massive haemoptysis: a case report

Diego José Rodríguez Torres  1 , Diego Segura Rodríguez  2 , Eduardo Moreno Escobar  2 , Rocío García Orta  1
Affiliations
Case Reports

Infective endocarditis on interventricular communication as cause of massive haemoptysis: a case report

Diego José Rodríguez Torres et al. Eur Heart J Case Rep. .

Erratum in

Abstract

Background: Haemoptysis is a rare symptom associated with endocarditis. We describe the unusual clinical manifestation of endocarditis on regurgitant bicuspid aortic valve and (probably) secondarily on a perimembranous ventricular septal defect (VSD) as massive haemoptysis.

Case summary: A 24-year-old male with aortic coarctation, bicuspid aortic valve, and VSD since birth. Previously asymptomatic, he came after an episode of haemoptysis. A computed tomography (CT) scan showed a cavitated lesion in lung. Streptococo viridans was identified in serial blood cultures. Transthoracic echocardiography showed a bicuspid aortic valve with vegetations, suggesting infectious involvement, and severe aortic insufficiency. Transoesophageal echocardiography (TEE) study showed a bicuspid aortic valve with complete fusion of coronary valves. An elongated oscillating tumour, 9.5 mm in length, was observed in the centre of the ventricular side of the non-coronary valve. Another vegetation was seen on the VSD. During his hospital stay and under antibiotic treatment, he reported abdominal pain. Computed tomography examination showed splenic infarction. In the echocardiogram no vegetation masses were observed on the aortic valve or on the VSD closure aneurysm.

Discussion: The main debate about this patient's treatment concerned the indication of surgery, especially after the onset of fever with splenic septic embolism while under appropriate antibiotic treatment. He was stable, with no signs of heart failure and the echocardiogram repeated after the septic splenic embolism showed no residual vegetations on the aortic valve or VSD, and the TEE study ruled out a local complication. Finally, the multidisciplinary team decided against surgical management.

Keywords: Case report; Congenital heart malformation; Endocarditis; Haemoptysis.

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Figures

Figure 1
Figure 1
Parasternal long-axis view of the right ventricular inflow tract/left ventricular outflow tract: *ventricular septal defect, **vegetation on aneurysm, ***ventricular septal defect aneurysm, ****tricuspid valve, *****aortic valve.
Figure 2
Figure 2
Mid-oesophageal aortic valve long-axis view with vegetations: *aortic valve, **ventricular septal defect closure aneurysm.
Figure 3
Figure 3
Axial scan displaying pulmonary infarction (A) and splenic infarction (B).
Figure 4
Figure 4
Parasternal long-axis view, with no vegetation on the aortic valve.
Figure 5
Figure 5
Mid-oesophageal aortic valve long/short axis view of with no previous vegetation. *ventricular septal defect, **aneurysm, ***aortic valve.
Figure 6
Figure 6
Mid-oesophageal aortic valve long/short axis view with colour Doppler imaging, disclosing severe aortic regurgitation that had regressed with respect to the previous study.
See this image and copyright information in PMC

References

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