Figure 3.

Cardiac computed tomography. A large hypoattenuated mass consistent with a vegetation (red arrows) is associated with the mechanical aortic valve (A) and protrudes through the valve in systole (B). There is thickening of the mitral-aortic intervalvular fibrosa (yellow arrow), suggestive of perivalvular involvement (C). No abscess was identified. Lead position within the right ventricular apex (green arrows) following magnetic resonance imaging is demonstrated in 4-chamber (D) and modified 2-chamber views (E).