A 61-year-old woman presented with a history of infiltrating ductal carcinoma of the left breast subjected to radiotherapy, and several episodes of left-side mastitis secondary to radiodermatitis. The patient was admitted due to fever and diminished consciousness. The diagnosis was initially assumed to be bacterial meningitis, but was subsequently reoriented toward mastitis with oxacillin-sensitive Staphylococcus aureus bacteremia. The intensivists in the ICU performed clinical transthoracic echocardiography from the apical window and focused on the mitral valve (Fig. 1), which revealed moderate valve insufficiency with suspected endocarditis of the posterior leaflet (arrows). A first protocolized transthoracic echocardiographic study was requested and performed in the ICU by the Department of Cardiology, with the exclusion of endocarditis. The patient was moved to the ward, and after 24h developed fever and severe supraventricular tachycardia. Admission to the Coronary Unit was decided, where a protocolized transesophageal echocardiographic study from the mid-esophageal window and focused on the mitral valve with 3D reconstruction (“surgeon view”) (Fig. 2) confirmed the presence of an endocarditis vegetation on the posterior leaflet (arrow) of the native mitral valve calcified by irradiation.

Figure 1

Figure 2