Emergency department point of care
ultrasound utility in diagnosing infective
endocarditis presenting as abdominal pain
with bilateral iliac occlusion

Emergency department point of care
ultrasound utility in diagnosing infective
endocarditis presenting as abdominal pain
with bilateral iliac occlusion

Infective Endocarditis (IE) is a life threatening disease

Abstract
Background Infective Endocarditis (IE) is a life threatening disease which is relatively rare especially in young healthy
adults, and patients can rapidly deteriorate due to valvular insufficiency; however diagnosis can be challenging in the
Emergency Department (ED).
Case presentation We present a case of a 37 year old male who attended the ED with fever, diarrhoea and
abdominal pain for one week. On arrival, he was febrile and tachycardic with right iliac fossa tenderness. Computed
Tomography scan of the Abdomen and Pelvis revealed splenic and left kidney infarcts with bilateral iliac artery
thrombi. Bedside Point Of Care Ultrasound (POCUS) showed a large Mitral Valve vegetation which supported the
diagnosis of infective endocarditis with septic emboli. The patient was given intravenous antibiotics, crystalloids
and antipyretics. He was urgently referred to Cardiology and Cardiothoracic surgeons for definitive surgical
management, and was subsequently intubated due to worsening hypoxia from acute valvular insufficiency
complicated by heart failure. The same night, he underwent emergency mitral valve replacement and embolectomy
of bilateral iliac arteries. Blood cultures grew Group B Streptococcus. During his stay, he developed multiple mycotic
pseudoaneurysms and a left insular cortex infarct as complications from the septic emboli.
Conclusions This patient had an atypical presentation of infective endocarditis in the ED, and bedside POCUS was
one of the keys to the diagnosis. Although infective endocarditis is rare, emergency physicians should be aware of the
diagnosis and its potential complications, and consider it in prolonged fever without a clear source. Bedside POCUS
can be a valuable first-line imaging tool in the ED to rule in the diagnosis of IE, and to look for complications as well
as indications for surgical intervention. Further research needs to be done to look at the sensitivity and specificity of
POCUS compared to routine Transthoracic Echocardiogram/ Transoesophageal Echocardiogram.

Elizabeth Ming Jing Tan1*, Yee Kent Liew2

, Zhi-Yang Darren Low1

, Helen Yuan Zhang1

and Ivan Si Yong Chua1

https://doi.org/10.1186/s12245-025-01028-6

2025

Peri Irawan

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