PMC7644799_01
Posterior and anterior pericardial effusion (E), The vegitation attached to mital valve and submital apperatus (M).
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Chest radiography revealed significant cardiomegaly with bilateral pleural effusion, while trans-thoracic echocardiography (TTE) revealed two vegetations in the left ventricle (LV): one was attached to the anterior mitral valve (MV) leaflet with significant MV regurgitation and the other was an elongated mass attached to the MV chordae, without any other vegetation in the aortic valve or the right side of the heart (Fig. 1).
CT scan of brain with perfusion study shows right Middle Cerebral Artery and Anterior Cerebral Artery territorial involvement.
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Brain CT confirmed the presence of multiple small brain abscesses with a new right hemisphere infarction consistent with an infarction in the territories of the right middle and anterior cerebral arteries (Fig. 2).
Left ventricle vegitation.
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MV leaflet (PMVL) (Fig. 3). Most of the primary chordae of the posterior mitral leaflets where eaten out and ruptured as well as some of the anterior mitral leaflet.
2D and color doppler of the pseudoaneurysm (P) with color aliasing at the connection with left ventricle.
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Follow up TTE were performed in the next three weeks which revealed a progressive localized dilatation in the LV at the posterior MV attachment site, consistent with an LV pseudoaneurysm (Fig. 4).