2.1 Diagnostic workup
During the hospital stay, the patient underwent diagnostic and therapeutic workup as appropriate (Figure 1). High-resolution computed tomography (HRCT) revealed multiple peripheral patchy ground glass opacities at both lung fields associated with pneumonic consolidation (Figure 2). The patient received the standard treatment of COVID-19 pneumonia with no need for mechanical ventilation.
Persistant fever and tachycardia with elevated D-dimer and thrombocytopenia indicated bedside transthoracic echocardiography (TTE) which revealed large mobile tricuspid valve mass, mostly thrombus, measuring 33 x 17 mm and protruding into right atrium (RA) and right ventricle (RV), with moderate-to-severe TR and moderate pulmonary hypertension. Furthermore, cardiac magnetic resonance (CMR) showed TVT of 28 x 21 x 11mm oscillating into the right ventricle with preserved ventricular function (Figure 3). Blood culture showed no growth.