Vegetation with ventricular septal defect detected by cardiac magnetic resonance imaging.

lthough transthoracic echocardiography is a well-established method of diagnosing vegetations in patients with infective endocarditis, its sensitivity for detection is relatively low and is operator-dependent. 1,2 We present a case of infective endocarditis in a patient with ventricular septal defect (VSD), diagnosed by cardiac magnetic resonance imaging (MRI). A 17-year-old man previously known to have a VSD was referred because of recurrent fever. On admission, his temperature was 37.8°C. His lungs were clear on ausculta-tion. A 4/6 pansystolic murmur was heard at the apex. No embolic findings were observed. White blood cell count was 13,160 / μl, and blood cultures were positive for Streptococcus intermedius. Transthoracic echocardiography revealed the VSD and a small mobile structure adjacent to the VSD, which was suggestive of a vegetation (Figure 1A). Cardiac MRI was subsequently performed to assess cardiac function and the presence of vegetation using a 1.5 Tesla cardiac MR imager (CV/i, A Figure 1. (A) Transesophageal echo-cardiography with short-axis view showing the vegetation adjacent to the VSD (white arrow). (B) Cardiac cine MRI with short-axis view showing the vegetation adjacent to the VSD (black arrow). (C) Cardiac cine MRI with 4-chamber view showing the vegetation adjacent to the VSD (white arrow). (D) First-pass contrast-enhanced perfusion MRI with 4-chamber view showing the vegetation adjacent to the VSD, which was not enhanced by contrast media (white arrow). VSD, ventricular septal defect; MRI, magnetic resonance imaging.