PULMONARY EMBOLISM AND FEVER: WHEN SHOULD I THINK TO RIGHT-SIDED INFECTIVE ENDOCARDITIS?

Low-grade short-lived fever in pulmonary embolism is usually a benign sign and does not need further investigation. Contrariwise, high-grade fever is often due to another cause. Among patients with fever not justified by pulmonary embolism alone, and without computed tomography findings potentially explaining fever or septic pulmonary embolic phenomena, it is crucial to have a high clinical suspicion of right-sided infective endocarditis. Right-sided infective endocarditis is indeed a common cause of septic pulmonary embolism, and if not promptly recognized and treated causes significant mortality and morbidity. Right-sided infective endocarditis is difficult to disclose by computed tomography, even if some features could occasionally suggest its presence. In this clinical scenario, echocardiography should be performed without delay, since it correctly diagnoses right-sided infective endocarditis and addresses the physician to proper antimicrobial or surgical therapy (Figure).