In a patient with bacterial endocarditis, which of the following echocardiographic lesions is most likely to lead to embolization?
ExplanationWhile any valvular vegetation can embolize, vegetations located on the mitral valve and vegetations >10 mm are at the greatest risk of embolizing. Of the choices given, C, D, and E are large enough to increase the risk of embolization. However, only choice D demonstrates the risks of both size and location. Hematogenously seeded infection from an embolized vegetation may involve any organ, but particularly affects those organs with the highest blood flow. Embolisms are seen in up to 50% of patients with endocarditis. Tricuspid lesions will lead to pulmonary septic emboli, common in injection drug users. Mitral and aortic lesions can lead to embolic infections in the skin, spleen, kidneys, meninges, and skeletal system. A dreaded neurologic complication is mycotic aneurysm, focal dilations of arteries at points in the arterial wall that have been weakened by infection in the vasa vasorum or septic emboli, leading to hemorrhage
