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Pulsatile torso: giant cardiomegaly from untreated tricuspid endocarditis
  1. Adam James Nelson,
  2. Ross Laurence Roberts-Thomson,
  3. Michael Benjamin Stokes,
  4. Angus Albert Baumann,
  5. Stephen James Nicholls
  1. Department of Cardiology, Royal Adelaide Hospital, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  1. Correspondence to Dr Adam James Nelson, Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; adam.nelson{at}

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A 32-year-old woman presented with abdominal pain, dyspnoea and associated fevers. Five years previously, she had been diagnosed with tricuspid valve endocarditis secondary to streptococcus mutans bacteraemia in the setting of long-standing active intravenous drug use. At this time, she was found to have two large vegetations (2.3×0.8 cm+2.2×0.9 cm) attached to her tricuspid valve and her right heart was normal size with mild tricuspid regurgitation only. Unfortunately, she only completed 48 hours of antibiotics before discharging against medical advice. Social function was compromised by domestic violence, financial hardship and isolation, which resulted in repeated self-discharge from hospital and poor medical compliance. Over the course of the ensuing 3 years, a further nine hospital …

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  • Contributors AJN conceived of the manuscript, wrote the manuscript and is guarantor of the content. RLR-T provided critical review of the manuscript. MBS provided critical review of the manuscript and assisted with image editing. AAB created the image montage and provided critical review of the manuscript. SJN was the attending medical officer and provided critical review of the manuscript and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note Selected echocardiography sequences are provided as an online supplement.