Septic pulmonary emboli from pulmonic valvular endocarditis demonstrated by serial ventilation-perfusion lung imaging

The evolution of multiple ventilation-perfusion mismatches on serial lung scintigraphy in a fully anticoagulated, bacteremic patient with small pulmonary infiltrates and repeatedly negative Doppler ultrasonography of the lower extremities suggested pulmonary emboli from right-sided valvular endocarditis. The demonstration of pulmonic valvular vegetations on follow-up transesophageal echocardiography supported this diagnosis. In the proper clinical setting, septic pulmonary emboli should be included in the differential diagnosis of high-probability ventilation-perfusion lung imaging.