# Unexpected Infective Endocarditis Presenting With Multiple Pulmonary Emboli Despite Negative High-Risk Imaging

## TL;DR

A patient with infective endocarditis had multiple lung emboli but normal heart imaging, challenging typical diagnostic expectations.

## Contribution

This case report presents an atypical clinical scenario where IE was diagnosed despite negative cardiac imaging.

## Key findings

- Infective endocarditis was confirmed in a patient with multiple pulmonary emboli.
- Transthoracic and transesophageal echocardiography results were negative.
- The case challenges the assumption that embolic events always correlate with visible cardiac vegetations.

## Abstract

Infective endocarditis (IE) is notorious for causing septic emboli in major organs, especially the brain, spleen, and lungs. These emboli are expected to be caused by the shedding of vegetations that form on the endocardium of the heart. Therefore, positive findings of IE are generally expected on cardiac imaging, such as transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), when septic emboli are identified in a high-risk patient. This case highlights negative TTE and TEE findings in a patient with infective endocarditis who had an extensive burden of bilateral, multiple pulmonary emboli.