The serum white blood cell count was 26,000/mm3
with a profound neutrophilia and 10 to 24 bands/100
WBC. The hemoglobin was 6.9 g/dL, platelets were
17,000/mm3, and lactate was 7.4 mmol/L. The chemistry
panel was significant for bicarbonate of 17 mmol/L,
creatinine of 1.55 mg/dL, and blood urea nitrogen of
68 mg/dL. Urinalysis revealed greater than 50 red blood
cells per high power field without white blood cells, bacteria,
or casts. Chest radiography demonstrated multiple
bilateral mid-lung opacities. The central venous catheter
tip was seen in the proximal superior vena cava.
A bedside cardiac EUS was performed by the EP.
Using the subxiphoid cardiac window, a large vegetation
was visualized on the tricuspid valve. In addition, the
right atrium appeared enlarged [see Additional file 2:
Image 2 and Additional file 3: Video 1]. Using color flow
Doppler imaging, regurgitation was noted across the
tricuspid valve [see Additional file 4: Image 3 and
Additional file 5: Video 2]. A view taken from the apical
four-chamber approach provided an additional view of
the tricuspid vegetation [see Additional file 6: Image 4
and Additional file 7: Video 3].
The serum white blood cell count was 26,000/mm3
with a profound neutrophilia and 10 to 24 bands/100
WBC. The hemoglobin was 6.9 g/dL, platelets were
17,000/mm3, and lactate was 7.4 mmol/L. The chemistry
panel was significant for bicarbonate of 17 mmol/L,
creatinine of 1.55 mg/dL, and blood urea nitrogen of
68 mg/dL. Urinalysis revealed greater than 50 red blood
cells per high power field without white blood cells, bacteria,
or casts. Chest radiography demonstrated multiple
bilateral mid-lung opacities. The central venous catheter
tip was seen in the proximal superior vena cava.
A bedside cardiac EUS was performed by the EP.
Using the subxiphoid cardiac window, a large vegetation
was visualized on the tricuspid valve. In addition, the
right atrium appeared enlarged [see Additional file 2:
Image 2 and Additional file 3: Video 1]. Using color flow
Doppler imaging, regurgitation was noted across the
tricuspid valve [see Additional file 4: Image 3 and
Additional file 5: Video 2]. A view taken from the apical
four-chamber approach provided an additional view of
the tricuspid vegetation [see Additional file 6: Image 4
and Additional file 7: Video 3].
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