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A) Chest radiograph on initial admission showed multifocal airspace opacities concerning for pneumonia or septic emboli. B) Transthoracic echo showed 3 cm x 2.2 cm vegetation on the tricuspid valve complicated by severe tricuspid regurgitation.
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Her chest x-ray showed multifocal bilateral airspace opacities somewhat nodular in appearance which were worse than her radiograph from previous admission (Fig. 1A). A transthoracic echocardiogram (TTE) showed a large 3 cm x 2.2 cm vegetation on the tricuspid valve complicated by severe tricuspid regurgitation, a small pericardial effusion, and estimated pulmonary arterial pressures of 25 - 30 mmHg (Fig. 1B).
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Computer tomography pulmonary angiography showed diffuse pulmonary emboli and increased consolidative opacity in the left upper lung when compared to previous imaging, concerning for evolving pulmonary infarcts.
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Computer tomography pulmonary angiography showed only minimal improvement of extensive pulmonary artery emboli involving the left proximal pulmonary artery, the entire left lower pulmonary artery, and multifocal involvement of the right pulmonary artery (Fig. 2).