PMC8565684_01
Two-dimensional echocardiographic images of large hyperechogenic structures that loosely adhere to the leaflets of the tricuspid valve and protrude in the right atrium.
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The second cardiac ultrasound, performed by a different examiner 12 hours after admission, revealed beyond the initial findings, a hyperechogenic and mobile structure linked to the leaflets of the tricuspid valve (Figure 1).
Macroscopic examination of the right heart. Large endocardial vegetations are present on the atrial aspects of the tricuspid valve leaflets
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The post-mortem examination revealed a normal sized heart, with massive endocardial vegetations on the leaflets of the tricuspid valve (Fig. 2) and multiple abscesses on both lungs.
Microscopic examination of the endocardial vegetations. A. Vegetation that adheres to the endocardium, represented by fibrine, erythrocytes, leukocytes and bacteria (hematoxylin-eosin, x100); B. Arrows point to existing bacilli in the vegetation and on the surface of the endocardium (hematoxylin-eosin, x400)
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The microscopical examination of cardiac tissue showed that the vegetations were made up of fibrine, blood cells and bacteria (Fig. 3).