Unexpected Infective Endocarditis Presenting With Multiple Pulmonary Emboli Despite Negative High-Risk Imaging

Infective endocarditis (IE) is notorious for causing septic emboli in major organs, especially the brain, spleen, and lungs. These emboli are expected to be caused by the shedding of vegetations that form on the endocardium of the heart. Therefore, positive findings of IE are generally expected on cardiac imaging, such as transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), when septic emboli are identified in a high-risk patient. This case highlights negative TTE and TEE findings in a patient with infective endocarditis who had an extensive burden of bilateral, multiple pulmonary emboli.