Manuscript:
A 3-year old male child with Ventricular septal defect (VSD), diagnosed
at 3 months of age, now presented with respiratory distress, cough,
facial puffiness and swelling of bilateral legs. Transthoracic
echocardiography demonstrated vegetations on tricuspid and pulmonary
valves and the child was diagnosed to have Infective endocarditis (IE)
and being treated for the same. Chest radiography performed as a part of
imaging workup demonstrated a well- defined, lobulated peri-hilar
opacity in the left lung. Computed tomography angiography (CTA) was
performed for further evaluation, suggesting the peri hilar nodular
opacity to be a saccular pseudoaneurysm arising from left descending
pulmonary artery (LDPA), indicating a mycotic aneurysm formation in the
setting of IE (Figures 1a & 1b). Non-enhancing hypoechoic
lesions with fronded appearance are seen along tricuspid and pulmonary
valves which are compatible with vegetations (Figures 2a &
2b). Multiple filling defects were noted in segmental and sub-segmental
branches of bilateral lower lobe pulmonary arteries, which were
attributed to septic pulmonary emboli and bilateral lungs demonstrated
multiple cavitary and non-cavitary nodules compatible with septic emboli