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