1 INTRODUCTION
Infective endocarditis (IE) is an inflammatory disease caused by
endocardial infection with pathogenic microorganisms that can affect the
heart valve or atrioventricular wall endocardial surface, with
vegetation formation (e.g., thrombus)1. IE is common
in adults but not in children2, especially right-sided
infective endocarditis (RSIE)3. We shared two cases to
highlight the importance of diagnostic thinking in the ultrasound
diagnosis of RSIE.
2 CASE 1
A 6-year-old child was admitted to our hospital with a fever and cough.
The physical examination revealed a high body temperature, tachycardia,
and a holosystolic murmur between the three and four intercostals on the
left edge of the sternum. The laboratory tests of the peripheral blood
showed that the WBC count was 21.8 x 109/L with 83%
neutrophils, hemoglobin was 6.4 g/dL, and C-reactive protein was 10.1
g/dL. The chest x-ray showed focal pulmonary infiltrates, and multiple
blood cultures (24 h apart) were negative. Meanwhile, the transthoracic
echocardiography showed an overall enlarged heart and a subaortic
ventricular septal defect (VSD) of 0.4 cm with a left-to-right shunt
(Figure 1A). A 1.1 x 0.5 cm mass
was attached to the anterior tricuspid valve, interrupted in continuity,
and accompanied by severe tricuspid regurgitation (Figure 1B,C,D).
Considering all her features, vegetations on the tricuspid valve were
strongly suspected rather than thrombosis or rheumatic valvular heart
disease.