BMJ Case Reports 2011; doi:10.1136/bcr.10.2011.4943
  • Unusual presentation of more common disease/injury

Thirteen square centimetre mass causing syncope in a patient with device related infective endocarditis

  1. Carlos Pinto3
  1. 1Department of Cardiology, Coimbra’s Hospital Center and University, S. Martinho do Bispo, Coimbra, Portugal
  2. 2Department of Internal Medicine, Figueira da Foz’s District Hospital, Gala, Figueira da Foz, Portugal
  3. 3Department of Cardiothoracic Surgery, Coimbra’s Hospital Center and University, Coimbra, Portugal
  1. Correspondence to Dr Rui Providencia, rui_providencia{at}


A 68-year-old man presented with anorexia, weight loss and severe asthenia starting 2 months before and fever lasting over 2 weeks. Analytical study revealed increased C reactive protein and sedimentation velocity. While thoracic x-ray and urinalysis were unremarkable, blood cultures were consistently positive for Enterococcus faecalis. A thoracic echocardiogram revealed a very large vegetation adherent to the ventricular electrocatheter of the patient’s pacemaker, so parenteral antibiotics were started. During his stay at the internal medicine ward, patient suffered three syncopal episodes and maintained intermittent fever. A transesophageal ECG performed at a tertiary centre on the 14th day unmasked a 9–12 cm2 organised mass, ovoid and with regular borders, adherent to the ventricular electrocatheter at right atrium level and protruding to the ventricle at systole. Patient was referred for cardiothoracic surgery and a 13 cm2 mass was removed alongside the ventricular electrocatheter. Two weeks following surgery, patient remains stable and asymptomatic.


  • Competing interests None.

  • Patient consent Obtained.

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