PMC9639234_01
Radiograph in the right lateral projection at the first visit, visualizing significant cardiomegaly and pronounced congestion, irregular caudal lung dark-fields, characteristic of pulmonary edema. Gas is present in the stomach.
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Chest X-ray (CXR) revealed increased cardiac silhouette, signs of pulmonary edema (Figure 1 and 2).
Ventrodorsal view at the first visit. Signs of air bronchograms and pronounced symmetrical lung dark-fields, blurred heart silhouette, dilated lung vessels, and gas in the stomach.
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Chest X-ray (CXR) revealed increased cardiac silhouette, signs of pulmonary edema (Figure 1 and 2).
Radiograph of the right lateral projection on the next day, after intensive care. The radiograph shows no congestion and cardiomegaly.
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Parasternal position, long axis. The vegetations on the MV and AV can be seen, also one can see that the vegetation on the AV leaflet obstructs the left ventricular systole. Red arrow marks vegetative lesions.
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The anamnesis data we obtained, as well as the appearance of significant vegetations on the mitral and AV on echocardiogram within two days (Figure 4), opined with myocardial thickening, high troponin, severe hypotension, and hyperthermia allow us to state with high probability that our patient had infectious myoendocarditis possibly complicated by arterial thromboembolism, a detached piece of vegetation from AV or MV leaflet (Figure 5).
AV, short axis. Significant vegetation on the non-coronary AV leaflet is visible.
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The anamnesis data we obtained, as well as the appearance of significant vegetations on the mitral and AV on echocardiogram within two days (Figure 4), opined with myocardial thickening, high troponin, severe hypotension, and hyperthermia allow us to state with high probability that our patient had infectious myoendocarditis possibly complicated by arterial thromboembolism, a detached piece of vegetation from AV or MV leaflet (Figure 5).
PMC9639234_02
Chest radiograph, right lateral projection.
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CXR revealed: lung dark-fields, visualization of air bronchograms with a combination of bronchial pattern, caudal lobes of the lungs detached, visualization of interlobular notches, assessment of cardiac silhouette was difficult (Figure 6).
Right parasternal access along the short axis at the aortic root level. Signs of left atrial dilatation.
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Echocardiogram revealed: the ratio of left atrial size to aortic ring size from the right parasternal short-axis was 3.09 (Figure 7), which indicates severe signs of left atrial dilatation.
Left apical view. Vegetations on the MV leaflets.
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There were recorded vegetations on the anterior and posterior MV leaflets (Figure 8).
Left ventricular cavity in section. Red arrows mark the presence of thrombotic deposits on the MV leaflets.
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MV leaflets were ulcerated, with thrombotic deposits on both MV leaflets (Figure 9).
MV fragment with infiltration of lymphocytes and neutrophils.
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The endothelium was significantly pitted, and interstitial edema was detected with disorganization of fibrous structures (Figures 10).
Myocardial fragment with leukocyte infiltration, dystrophic changes in cardiomyocytes.
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Focal lymphoid infiltrations with leukocyte admixture were found in myocardial and pericardial fragments (Figure 11).
Lung microscopy. Signs of emphysema, presence of cellular infiltration.
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The bronchial wall lymphoplasmacytic infiltration with an admixture of segmented leukocytes (Figure 12-13).
Lung microscopy. Infiltration of the bronchial wall with lymphocytes and infiltration in the bronchial lumen presence of inflammatory cells.
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The bronchial wall lymphoplasmacytic infiltration with an admixture of segmented leukocytes (Figure 12-13).