Septic Pulmonary Thromboemboli in an Adolescent With Tetralogy of Fallot

Abstract

A 14-year-old adolescent man from the Republic of Congo, with no personal medical history, presented with progressive shortness of breath and exercise limitation. On clinical examination, he had a 3/6 systolic murmur and regular cardiac rhythm, and cyanotic fingers and clubbing, as well. Pulmonary auscultation was normal. No recent episode of fever or shivering or peripheral sign of endocarditis were reported. Pulse oxymetry showed oxygen saturation at 64%. The diagnosis of Tetralogy of Fallot was subsequently established. Laboratory results showed a normal white blood cell count with no abnormalities. The initial echocardiogram showed a large perimembranous septal defect of 1.5-cm diameter, an aortic override, a predominant right-to-left ventricular shunt, a severe infundibular pulmonary stenosis, and right ventricular hypertrophy. Left ventricular diameter was 39 mm at end-diastole, and the left ventricular ejection fraction was normal. A 4-mm mobile element was unexpectedly visualized at the level of the pulmonary valve. An ECG-gated multidetector pulmonary computed tomography angiogram with iodinated contrast injection was then performed to explore this unusual finding. Preoperative transesophageal echocardiography was not …