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A Patient with Septic Pulmonary Embolism Derived from the Tricuspid Valve Endocarditis Mimicking Chronic Thromboembolic Pulmonary Arterial Hypertension Takeru Nabeta 1 , Takayuki Inomata 1 , Ryuta Imaki 1 , Shunsuke Ishii 1 , Toshimi Koitabashi 1 , Naoyoshi Aoyama 1 , Shinzo Torii 2 , Tohru Izumi 1 1Department of Cardio-Angiology Kitasato University School of Medicine 2Department of Cardiovascular Surgery, Kitasato University School of Medicine Keyword: 感染性心内膜炎 , 敗血症性肺塞栓症 , 慢性血栓塞栓性肺高血圧症 , tricuspid infective endocarditis , pulmonary septic embolism , chronic thromboembolic pulmonary hypertension pp.973-977
Published Date 2012/9/15
DOI https://doi.org/10.11477/mf.1404102052
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 A 28-year-old woman, with a past history of drug abuse, had complained of remittent fever for over 2 months. Her chest X-ray showed patchy infiltrates in the bilateral fields, and her echocardiogram documented severe tricuspid regurgitation. The blood bacterial culture was positive for α-streptococci. However, she was not diagnosed as a patient with infective endocarditis because of no positive signs of intracardiac vegetation. Her therapy consisted of conventional antibiotics under a tentative diagnosis of bacterial pneumonia. In spite of complete recovery from pulmonary infiltrates and remittent fever, her exertional dyspnea and leg edema continued. Even diuretics and anticoagulants given to relieve chronic thromboembolic pulmonary hypertension could not improve her symptoms. Finally, to treat her refractory right-side heart failure, a tricuspid valve was operatively removed and replaced with an artificial one. At the time of the operation, a diagnosis of infective endocarditis seemed to be validated due to the lesions of the destroyed tricuspid valve and ruptured chorda tendineae. Using only conventional diagnostic tools, as in this case, right-sided endocarditis is often difficult to differentiate from other diseases such as chronic thromboembolic pulmonary hypertension and the presence of septic pulmonary embolism itself is a strong characteristic of this disease.


Copyright © 2012, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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