No abstract

A 57-year-old man was admitted with right lower lobe pneumonia. He had had rheumatic fever as a child and 21 years later had a mitral valve replacement. He developed prosthetic valve endocarditis and the valve was replaced 9 months later. Para-prosthetic valve regurgitation developed and 4 years later he again required mitral valve replacement. He had been successfully treated for radiologically proven right lower lobe pneumonia several months after the second valve replacement but did not have a significant history of pulmonary disease. Chest X-ray on admission showed consolidation in the right lower lobe with an associated pleural effusion ( figure 1). An electrocardiogram showed atrial fibrillation.A chest X-ray performed after treatment showed radiographic resolution of the pneumonia. He re-presented 4 months later with a further right lower lobe pneumonia. A computed tomography (CT) scan of the thorax was performed (figure 2) and bronchoscopy was carried out.