PMC6276409_01
(a) Computed Tomography (CT) of the abdomen and the pelvis without contrast showing large wedge-shaped splenic infarcts. (b) CT of head without contrast displaying hypodensities in the left parietal lobe and left cerebellum due to septic emboli, shown in red arrows.
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A CT of his abdomen and pelvis without contrast was performed which revealed hepatosplenomegaly with multiple large wedge-shaped areas of hypoperfusion in the spleen, concerning splenic infarctions (Figure 1(a)). A CT of the head without contrast was performed due to his altered mental status, which showed two areas concerning embolic infarcts in the left parietal lobe and the left cerebellum (Figure 1(b)), compared to the one obtained on admission.
Large aortic valve vegetations on echocardiogram, shown in red arrows.
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On hospital day 4, an urgent transesophageal echocardiogram (TEE) was performed which again demonstrated the large aortic valve vegetations (Figure 2), but it now demonstrated acutely deteriorating moderate to severe aortic regurgitation, which was different from the TTE findings a few days prior that only showed mild-moderate aortic insufficiency.