Isolated Pulmonary Valve Vegetations in a Patient with Gastric Lymphoma Diagnosed by Endoscopic Ultrasound

A thirty five year old man presented to the internal medicine department of Cairo University with anorexia, persistent vomiting and progressive weight loss of 2 months duration. The patient is known to be an I.V (intra venous) drug abuser for 6 years; he looked toxic with high grade resistant fever. CBC showed normal leucocytic count with relative PMN leukocytosis and lymphopenia. CRP titer was 179 mg/dl (N:<6mg/dl). The patient was referred for upper endoscopy that revealed mild narrowing at the cardia with exaggerated gastric folds suggesting infiltrating wall disease; however endoscopic biopsies were inconclusive. Due to the high clinical suspicion, EUS and EUS-FNA were done using Pentax EG-3830UT Echo-endoscope, connected to a HITACHI EUB-7000 sonography machine.