CTICasesMassive Tricuspid Valve Vegetations with Embolization
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Imaging findings
Initial CT shows huge vegetations associated with a bioprosthetic tricuspid valve, appearing as a massive filling defect in the right ventricle. A follow-up CT six days later demonstrates extensive embolization of this material into the right pulmonary artery and left lower lobe pulmonary artery, resulting in widespread pulmonary hemorrhage and infarction. The original large vegetations within the right ventricle are no longer visible.
Key takeaways
Patients with a history of IV drug abuse are prone to infective endocarditis and can develop massive tricuspid valve vegetations. These vegetations can rapidly embolize to the pulmonary arteries, leading to extensive pulmonary infarction and hemorrhage. Imaging can dramatically illustrate the progression from large vegetations to massive pulmonary emboli.
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