3 CASE 2
A 15-year-old child was diagnosed with congenital heart disease with
severe pulmonary stenosis and mild tricuspid regurgitation in our
hospital two years ago. However, the child was not treated then and is
now hospitalized with ”chest tightness and bilateral lower extremity
edema.” The physical examination showed that the cardiac dullness
boundary was enlarged to the left, the heart rate was fast, the heart
sound was weakened, and a systolic ejection murmur could be heard in the
second intercostal space of the left margin of the sternum. The chest
X-ray showed pulmonary edema, an infection index, a heart failure index,
and a D-dimer increase, and the blood culture was negative many times.
Meanwhile, the transthoracic echocardiography showed massive pericardial
effusion, decreased right ventricular enlargement and systolic function,
pulmonary valve stenosis, dilatation of the main pulmonary artery (about
4 cm in width), and multiple masses attached to the dilated pulmonary
artery (the larger one with about 1.6 × 0.7 cm (Figure 2). The patient’s
medical history was followed up with a fever as high as 38 °C. Thus, the
masses were considered vegetations based on the medical history and the
location of the masses.