CTICasesEnterococcal Endocarditis
Imaging findings
Serial chest radiographs in a 38-year-old woman demonstrate rapid onset of diffuse interstitial pulmonary edema, septal lines (Kerley B lines), and left atrial enlargement. Chest CT shows prominent, sausage-link-like dilated lymphatic spaces in the lung bases (septal lakes). Cardiac CT shows a subtle vegetation on the anterior mitral valve leaflet, and echocardiogram confirms destruction of the valve leaflet from Enterococcus endocarditis.
Key takeaways
Acute bacterial endocarditis (e.g., due to Enterococcus species) can cause rapid valvular destruction and severe mitral regurgitation, presenting as acute cardiogenic pulmonary edema. The rapid rise in pulmonary venous pressure leads to marked lymphatic dilatation in the lung bases, which presents on CT as classic 'septal lakes.' Identifying these findings should prompt immediate cardiac evaluation.
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