2.2.3.1 Radiography

It can be quite normal or shows a variety of findings, such as cardiomegaly, pulmonary septic emboli, or pleural effusion [4].

## 2.2.3.2 Echocardiography

The benefits that the echocardiography brought to the cardiology area are wellknown, and they can help us to detect anomalies related to IE. It is the gold standard imaging test for IE, becoming one of the first steps that we must do if IE is suspected [3, 9].

The same as the LSIE, the transthoracic echocardiography (TTE) is the first modality recommended to perform if RSIE is suspected. The sensitivity of TTE to detect vegetations is roughly 75% and its specificity over 90%. When the hunch of IE is high, but the TTE is negative, the transesophageal echocardiography (TOE) must be used because its sensitivity is higher than TTE, approximately 96%. Some experts indeed recommend TOE even if the TTE is positive for IE; nevertheless, it does not apply for RSIE in which an explicit finding of IE is enough for the diagnosis [5, 9].


#### Table 1.

Imaging technique findings in the right-sided infective endocarditis.

## Infective Endocarditis

The 2015 ESC guidelines also suggest the use of TOE when the suspicion of IE is present in patients with a prosthetic heart valve and intracardiac device [5].

There are some "typical lesions" of IE that we can detect in the echocardiography, such as vegetations, abscess, pseudoaneurysm, valve aneurysm, perforation, fistula, and dehiscence of the prosthetic valve, being the vegetation of the landmark lesion of this disease (Figure 1) [5, 9].

Occasionally, parts of the vegetations can be visualized floating in the right ventricle or entrapped in the subvalvular apparatus. TTE usually allows assessment of tricuspid valve involvement because of the valve's anterior location and large natural vegetations. TOE imaging is more sensitive to detect vegetations than TTE imaging, especially in the case of abscesses, and associated left-sided involvement [6].
