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Large mural vegetation from right ventricle, accompanying tricuspid valve endocarditis

A 48-year-old man, with no history of intravenous drug abuse, presented to us with high-grade fever, cough and haemoptysis of 2 months duration. On examination, there was sinus tachycardia at 100 beats per minute, normal blood pressure and a short systolic murmur at apex. He had neutrophilic leukocytosis, elevated erythrocyte sedimentation sate and C-reactive protein levels were elevated. Chest x-ray showed non-homogenous opacities in right lower zone (figure 1A). Computerised tomography of the thorax revealed multiple cavitating nodules suggestive of septic pulmonary embolism (figure 1 …