# Multimodality Imaging of Intracardiac Lesions in a Lung Transplant Patient: Atypical Presentation of Culture-Negative Endocarditis

## TL;DR

A lung transplant patient with negative blood cultures showed heart lesions, and imaging helped diagnose culture-negative endocarditis despite surgical risks.

## Contribution

Demonstrates the diagnostic value of multimodality imaging in atypical cases of culture-negative endocarditis in immunocompromised patients.

## Key findings

- Multimodality imaging helped identify intracardiac lesions in a patient with negative blood cultures.
- Conservative antibiotic treatment was effective in managing the patient's condition.
- Culture-negative endocarditis should be suspected in immunocompromised patients with thrombotic risk factors.

## Abstract

Intracardiac lesions in immunocompromised patients with negative blood culture pose a diagnostic challenge, particularly when both thrombus and infective endocarditis are possible etiologies.

A young woman with a history of lung transplantation on immunosuppression and thrombophilia was found to have new hypermetabolic, mobile lesions involving the interventricular septum. Blood cultures were negative, and owing to prohibitive surgical risk, she was managed conservatively with antibiotics, with an excellent response.

This case highlights the diagnostic complexity and the role of multimodality imaging associated with defining the etiology and treatment plan for intracardiac lesions in a patient with multiple medical comorbidities.

Culture-negative endocarditis requires a high index of suspicion in immunocompromised patients with thrombotic risk factors and inconclusive microbiological and echocardiographic findings.