Diagnosis of Right Ventricular Vegetation on Late Gadolinium-Enhanced MR Imaging in a Pediatric Patient after Repair of a Ventricular Septal Defect

Abstract

We report a case of vegetation in a 4-year-old female with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. The patient had a history of primary closure for ventricular septal defect and presented with mild febrile sensation. No remarkable clinical symptoms or laboratory findings were noted; however, transthoracic echocardiography demonstrated a 14 mm highly mobile homogeneous mass in the right ventricle. On LGE CMR imaging, the mass showed marginal rim enhancement, which suggested the diagnosis of vegetation rather than thrombus. The extracellular volume fraction (≥ 42%) of the lesion was higher than that of normal myocardium. Based on the patient's clinical history of congenital heart disease and pathologic confirmation of the lesion, a diagnosis of infective endocarditis with vegetation was made.

Thrombus or vegetation?Importance of cardiac MRI as a diagnostic tool based on case report and literature review

“…Differentiation between vegetation and thrombus can be difficult, because both can have a similar aspect on LGE-MRI [ 7 ]. In Case of infective endocarditis, some authors report cases of marginal mass enhancements on LGE-MRI [ 8 ], which could facilitate the differentiation between vegetation and thrombus. Other results suggest that cardiac MRI may show endocardial LGE reflecting irreversible endocardial damage or fibrosis, and may also show perivalvular abscess [ [9] , [10] , [11] ].…”