After 48 hours, a subcostal view of the inferior vena cava joining the right atrium in a second TTE detected a prominent Eustachian valve with mobile multilobulated vegetation attached (Figure 1; Supplementary Materials (available here)).
Repetition of TTE detected a reduction in the size of the vegetation, favoring the diagnosis of Eustachian valve endocarditis.
After platelet normalization, ASA and enoxaparin were started and after 5 days, a repeated TEE showed a significant decrease in the size of the echogenic right ventricular mass (1.38 x 0.4 cm) and disappearance of the echogenic mass on the
Eustachian valve of the inferior vena cava, confirming intracardiac thrombosis.