PMC6590612_01
Right first toe with Janeway lesion (vascular emboli phenomena).
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On exam, he had significant bibasilar crackles as well as a holosystolic apical murmur; additionally, he was found to have 2+ lower extremity edema and several punctuate macular lesions on his feet, highly suspicious for vascular emboli phenomena (Figure 1).
Arrowhead: TTE showing a mobile mass on the posterior leaflet of the mitral valve consistent with a vegetation.
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Ejection fraction was calculated to be 40% (Figure 2).
(a) TEE image of vegetation on posterior leaflet of mitral valve, measuring "1.42 cm x 2.52 cm" (arrowhead). (b) TEE image with evidence of blood flow regurgitation with Doppler into the left atrium in the setting of the mitral valve posterior leaflet vegetation.
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At day 5, the patient received a transesophageal echocardiogram (TEE) which confirmed a "1.4 cm x 2.5 cm" vegetation attached to the posterior leaflet of mitral valve (Figure 3(a)), with severe mitral regurgitation and posterior leaflet perforation (Figure 3(b)).