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(Circulation. 2007;115:e173-e176.)
© 2007 American Heart Association, Inc.

Clinician Update

Pulmonary Embolism and Fever

When Should Right-Sided Infective Endocarditis Be Considered?

Gaetano Nucifora, MD; Luigi Badano, MD; Fjoralba Hysko, MD; Giuseppe Allocca, MD; Pasquale Gianfagna, MD; Paolo Fioretti, MD

From the Departments of Cardiopulmonary Science (G.N., L.B., G.A., P.G., P.F.) and Radiological Science (F.H.), Azienda Ospedaliero-Universitaria di Udine, Udine, Italy.

Reprint requests to Gaetano Nucifora, MD, Cardiopulmonary Science Department, Azienda Ospedaliero-Universitaria di Udine, P. le S. Maria della Misericordia 15, 33100 Udine, Italy. E-mail gnucifora@cardionet.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case presentation: A 39-year-old woman with chronic alcoholism became febrile (38.8°C) and markedly dyspneic on the fourth postoperative day of gastric surgery. Laboratory evaluation revealed anemia (hemoglobin 8.5 g/dL), thrombocytopenia (platelet count 30 000/mm³), and elevation of inflammatory markers (white blood cell count 18 000/mm³, C-reactive protein 187 mg/dL, and erythrocyte sedimentation rate 50 mm/s). Limb venous ultrasonography was negative for deep vein thrombosis, but pulmonary embolism (PE) was diagnosed on the basis of contrast-enhanced multidetector-row spiral computed tomography (MSCT; Figure 1A). Anticoagulation therapy was considered to be contraindicated because of recent surgery and thrombocytopenia, and a retrievable inferior vena cava filter was placed. With persistent high-grade fever and dyspnea and with the finding of Streptococcus agalactiae bacteremia, the patient underwent a transthoracic echocardiography examination on the sixth postoperative day that showed a large, mobile vegetation attached to the pulmonary valve (Figure 1B). A diagnosis of infective endocarditis (IE) of the pulmonary valve complicated by septic PE was then made, and the patient was referred for vena cava filter removal and pulmonary valve replacement. During vena cava filter removal, an acute thromboembolic stroke occurred, and transesophageal echocardiography documented a patent foramen ovale with right-to-left shunt. Ten days later, the patient underwent successful pulmonary valve replacement and surgical closure of the patent foramen ovale.

View larger version (87K):   Figure 1. A, MSCT shows a large filling defect in the main pulmonary artery, above the pulmonary valve (black arrow), and a filling defect in the terminal part of the right pulmonary . . . [Full Text of this Article]

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Circulation 2007 115: 677. [Extract] [Full Text]

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