Isolated Endocarditis of Native Pulmonary Valve in a Pediatric Patient: The Unusual within the Unusual

Figures

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  Figure 1. Anteroposterior chest radiograph demonstrating multiple bilateral hazy opacities as well as pleural effusions.

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  Figure 2. Chest computed tomography without contrast. (A, B) Axial views demonstrating multiple solid and cavitary pulmonary lesions, some with air fluid levels (blue arrow) consistent with diffuse septic emboli (yellow arrows), bilateral pleural effusions (stars). (C, D) Coronal views with multiple solid and cystic lesions (yellow arrows) and small right pneumothorax (red arrow).

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  Figure 3. TTE. Subcostal view (A), parasternal long-axis (B) and short-axis (C) views demonstrating thickened PV (yellow arrow) and possible vegetation. (D) Parasternal long-axis color-compare image with thickened PV. (E) Spectral Doppler image showing mild pulmonic stenosis (peak gradient 22 mm Hg) and moderate regurgitation. AO, Aorta; PA, pulmonary artery; RVOT, right ventricular outflow tract.

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  Figure 4. Preoperative TEE. (A, B) Two-dimensional (2D) and three-dimensional images showing large lobulated mass attached to the PV (white arrow). (C) Color Doppler image demonstrating moderate pulmonary regurgitation (yellow arrow). (D) Postoperative 2D and color-compare transesophageal echocardiographic images showing normal pulmonary homograft function without regurgitation (green arrow). AO, Aorta; LA, left atrium; LV, left ventricle; MPA, main pulmonary artery; RVOT, right ventricular outflow tract.

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  Figure 5. Photomicrograph of excised pulmonic valve. (A) Histologic section of the vegetation shows abundant colonies of bacterial microorganisms that appear basophilic in a background of fibrin (hematoxylin and eosin, 100× magnification). (B) The microorganisms are stained gram positive (200× magnification). Inset shows Grocott methenamine silver stain that demonstrates the morphology of bacteria as cocci (600× magnification).

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  Figure 6. Axial view on chest computed tomography without contrast showing resolution of previously seen lung lesions with scattered areas of parenchymal scarring and a residual cyst (yellow arrow) in the left lower lobe.

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  Figure 7. Postoperative TTE. (A, B) Parasternal short-axis view demonstrating normal prosthetic PV function. (C) Spectral Doppler across the right ventricular outflow tract (RVOT) showing no stenosis or regurgitation. PA, Pulmonary artery.