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.