PMC6636574_01
(a) Transthoracic echocardiogram on parasternal long axis view shows independently mobile echo dense structure of 1.61 cm x 0.82 cm on the LVOT side, likely vegetation. (b) Transesophageal echocardiogram mid esophagus long axis view shows the aortic valve with the aortic valve vegetation.
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The initial laboratory parameters reveal hemoglobin of 8.5 g/dl and white cell count of 9.2 x I09 cell/dl (83.6% neutrophils); transthoracic echocardiogram showed preserved ejection fraction, moderate aortic stenosis, and regurgitation with thickening of the aortic valve and independently mobile echo dense structure on the left ventricular outflow tract measuring 1.61 x 0.82 centimeters (see Figure 1(a)). Transesophageal echocardiogram showed tricuspid aortic valve with moderate aortic stenosis, moderate aortic regurgitation, and large aortic valve vegetation of 0.45 cm x 1.3 cm attached to right cusp (see Figure 1(b)).
High-definition colonoscopy images showing pedunculated polyp in the ascending colon and a nonpedunculated polyp in the sigmoid colon.
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The colonoscopy revealed a 35 mm polyp in the sigmoid colon and another 30 mm polyp in the descending colon (see Figures 2(a) and 2(b)), both removed with hot snare polypectomy.