A 69-year-old man, with a history of myocardial infarction and implantation of a permanent pacemaker because of sinus arrest, presented with periodic shortness of breath and fever. Laboratory evaluation showed an elevated C-reactive protein level and leucocytosis, but blood cultures were negative. Because computerised tomography (CT) of the thorax revealed bilateral pulmonary emboli and abdominal ultrasound was suspect for cholecystitis, the correct diagnosis and treatment were delayed. Additional transthoracic echocardiography (TTE), however, revealed a large mobile right atrial mass attached to the pacemaker lead suspect of vegetation (Fig. 1a) causing right-sided endocarditis.
Fig. 1
a TTE: mobile right atrial mass attached to the pacemaker lead suspect of vegetation b TEE: large mobile mass attached to the pacemaker lead suspect of vegetation
