Patent ductus arteriosus endarteritis in a 40-year old woman, diagnosed with Transesophageal Echocardiography. A case report and a brief review of the literature

Two-dimensional echocardiography (transthoracic & transesophageal) is the most sensitive and widely used method in identifying vegetations associated with IE, as well as in detecting the underlying heart disease, even in cases of clinically silent PDA (no symptoms, no murmur).A forty-three year old Caucasian woman, with no history of heart disease, was admitted to the hospital due to prolonged fever, palpitations, fatigue and loss of body weight (10 kg) during the past 2 months. Two months before, she had undergone a complicated tooth extraction, which was not completed. The patient did not follow the antibiotic treatment prescribed by the Dentist after the procedure. Twenty-four hours later she developed high fever with chills. During the following two months, her temperature showed fluctuations and was partially controlled with simple analgesic and antipyretic drugs. She did not complain for any other symptoms. It was the marked weakening and palpitations, which led her to seek for medical help.No further substantial information was obtained from the personal medical and family history of the patient. A few years ago an echo was suggested to her due to a loud systolic murmur, but she did not follow this advice. On physical examination, she appeared to be lean, suffering, with poor dental hygiene. Her BP was 100/75 mmHg, HR was 110 bpm and respiratory rate was 20 breaths/min. There was a palpable thrill and a 4–5/6 continuous murmur with late systolic accentuation at the upper left sternal border. Pulmonary fields were clear on auscultation. The spleen was palpable 4 cm under the left subcostal border. Laboratory investigations revealed hypochromic anemia with microcytosis (Hb 9.66 g/dl), normal white cell count and ESR of 100 mm at the 1st hour. Renal and liver function were normal. A chest x-ray film demonstrated a consolidation at the base of the right lung and chest CT revealed pulmonary infiltrations in both lungs, suggesting septic emboli (Figure 1,2). Blood