SHM Converge Scientific Abstract ePoster Gallery-Right Atrial Embryonic Remnants: Infectious Endocarditis in a Patient With Chiari Network

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A 58-year-old woman with hypertension and alcohol use disorder presented with two weeks of fever, chills, confusion, cough, headache, and auditory hallucinations. She was lethargic but alert and oriented. Laboratory testing showed marked inflammation and infection, including leukocytosis, elevated procalcitonin, CRP, and lactate. Viral testing was negative, and initial ECG and troponin were unremarkable.<br /><br />Chest CT revealed multiple bilateral cavitary pulmonary nodules, especially in the upper lobes and periphery, consistent with disseminated septic emboli. Blood cultures from separate sites grew Streptococcus anginosus, a viridans streptococcal species. Because of concern for infective endocarditis, transthoracic echocardiography was performed but showed no vegetations. Transesophageal echocardiography was also negative for vegetation, but it identified a Chiari network in the right atrium.<br /><br />The case highlights the possible role of right atrial embryonic remnants, such as Chiari networks, in predisposing patients to right-sided infective endocarditis. Although usually considered benign incidental findings, these structures may serve as a nidus for infection due to their complex anatomy. Their irregular appearance can also make vegetations difficult to detect on imaging, leading to underdiagnosis.<br /><br />Despite negative echocardiographic findings, the patient was treated with an antibiotic regimen appropriate for endocarditis, given the bacteremia and septic emboli. The report emphasizes that clinicians should consider congenital or embryologic right atrial structures when evaluating suspected endocarditis, particularly when imaging is inconclusive. Current guidance supports treating right-sided endocarditis empirically in appropriate clinical contexts even when characteristic vegetations are not visualized.

Asset Subtitle

Sharanya Manga

Meta Tag

Author List Ji-Yoon Park, Sharanya Manga, Witt A. Durden

Category Clinical Vignettes

Concept Infective Endocarditis

Concept Septic Emboli

Concept Right-sided Infective Endocarditis

Concept Streptococcus anginosus

Concept Bacteremia

Distinguished Non-Finalist

Presenter Organization Camc

Presenting Author Sharanya Manga

Track Adult

Keywords

Streptococcus anginosus

infective endocarditis

Chiari network

septic emboli

cavitary pulmonary nodules

bacteremia

right atrium

transesophageal echocardiography

viridans streptococci

antibiotic therapy

Infective Endocarditis

Septic Emboli

Right-sided Infective Endocarditis

Streptococcus anginosus

Bacteremia