Key result
TEE detects a Chiari network vegetation in right-sided infective endocarditis resolving with antibiotics.
Case Report (n=1)
This case highlights the importance of using TEE to evaluate the Chiari network and Eustachian valve in high-risk patients with suspected right-sided infective endocarditis when TTE is negative.
TEE may detect Chiari network vegetations missed by TTE in right-sided IE; leaves open prospective validation before routine use.
BACKGROUND AND CASE SUMMARY: A 46-year-old woman with intravenous heroin use presented with fever, respiratory symptoms, and methicillin-susceptible Staphylococcus aureus bacteremia. Thoracic computed tomography demonstrated multiple septic emboli. Transthoracic echocardiography revealed severe tricuspid regurgitation without vegetations. Transesophageal echocardiography (TEE) discovered a vegetation on the Chiari network and tricuspid leaflet perforation. She was successfully treated with antibiotics. Follow-up TEE showed resolution of the vegetation. DISCUSSION: This case highlights the Chiari network as an uncommon but clinically relevant substrate for right-sided infective endocarditis in high-risk patients. TAKE-HOME MESSAGE: In patients with risk factors for right-sided infective endocarditis with apparently no valvular vegetation on transthoracic echocardiography, the Chiari network and Eustachian valve should be evaluated with TEE.
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Choi et al. (2026) conducted a case report in Right-sided infective endocarditis (n=1). Transesophageal echocardiography (TEE) was evaluated on Resolution of vegetation. Transesophageal echocardiography successfully identified a vegetation on the Chiari network in a 46-year-old woman with right-sided infective endocarditis, which resolved with antibiotic therapy.