Clinical Images

Snow and Reindeer: Large Tricuspid Valve Mobile Vegetation

Peter C. Olson, MD1;  Vratika Agarwal, MD2;  Roman Royzman, MD2

Peter C. Olson, MD1;  Vratika Agarwal, MD2;  Roman Royzman, MD2

J INVASIVE CARDIOL 2018;30(12):E155.

Key words: cardiac imaging, sepsis, Streptococcus constellatus


A 20-year-old female with history of polysubstance abuse presented for fevers and lightheadness. Blood cultures grew out Streptococcus constellatus, which is known to form purulent infections when introduced in the body. Evaluation with transesophageal echocardiogram (TEE) showed a definite large, irregular, loosely organized, highly mobile vegetation, 1.7 x 3.5 mm on the septal leaflet base, and right atrial aspect with associated severe tricuspid regurgitation (Figure 1). The day after TEE evaluation, the patient expired secondary to overwhelming sepsis. 


From the 1Department of Internal Medicine and 2Department of Cardiology, Staten Island University Hospital-Northwell Health, Staten Island, New York. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted July 12, 2018. 

Address for correspondence: Peter C. Olson, MD, Staten Island University Hospital-Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305. Email: polson3@northwell.edu

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