Satellite atrial septal vegetations.

1 of 2 DESCRIPTION A 40-year-old lady was admitted with a week’s history of fever and dyspnoea. Transthoracic echocardiography revealed 0.5 × 0.5 cm vegetation on the posterior mitral leafl et with a severe eccentric mitral regurgitation (MR) hugging the left atrial aspect of anterior mitral leafl et and the interatrial septum (IAS) which was confi rmed by a transoesophageal echocardiogram ( fi gure 1A , arrows). Multiple vegetations were seen all along the anterior mitral leafl et (left atrial aspect) and into the IAS ( fi gure 1B , arrows). Her laboratory investigations showed elevated total white blood cell (WBC) counts (21 000cells/mm 3 ) and erythrocyte sedimentation rate (ESR) (121 mm/h). Blood culture grew Streptococcus viridans sensitive to ceftriaxone. Vegetations are known to occur at the site of endothelial denudation caused by a jet of blood. Multiple vegetations along the path of blood fl ow are common. Atrial septal endocarditis is uncommon but has been reported in patients in isolation and in association with endocarditis of other heart valves. 1