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Silent large vegetative mitral–aortic enterococcal endocarditis

Conte, Lucaa; Rossi, Andreab; Picariello, Claudioa; Zuin, Marcoa; Abbasciano, Riccardo G.c; Rigatelli, Gianlucad; Roncon, Lorisa

Journal of Cardiovascular Medicine: December 2016 - Volume 17 - Issue - p e199–e204
doi: 10.2459/JCM.0000000000000445
Images in cardiovascular medicine

In spite of the evolution of diagnostic and imaging tools, infective endocarditis still remains a challenging diagnostic problem. We report the case of a 77-year-old heart failure patient with a very large mitral vegetative lesion but without fever or any other clinical or microbiological ‘endocarditis criteria’ except the echocardiographic findings. In this scenario, the second more likely differential diagnosis was neoformation of the mitral valve but despite an exhaustive preoperative diagnostic cardiac imaging, this hypothesis could not be excluded before surgical excision and microbiological examination of the surgical specimen.

aDivision of Cardiology, Rovigo General Hospital, Rovigo

bDivision of Cardiology

cDivision of Cardiovascular Surgery, Verona University Hospital, Verona

dCardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy

Correspondence to Luca Conte, MD, Division of Cardiology, Rovigo General Hospital, Viale 3 Martiri 140, Rovigo, Italy. Tel: +39 425 393281; fax: +39 425 393597; e-mail:

Received 28 March, 2016

Revised 22 July, 2016

Accepted 20 August, 2016

© 2016 Italian Federation of Cardiology. All rights reserved.