Patient was an intravenous drug user who had tricuspid regurgitation from previous endocarditis, who presented with fevers and hypotension. A systolic murmur was audible on auscultation
The right ventricular inflow view shows an echogenic mass (vegetation) attached to the anterior leaflet of the tricuspid valve. Color Doppler demonstrates the tricuspid regurgitation.
Tricuspid valve endocarditis (Staph Aureus grew on blood cultures)
Note that the non-visualization of vegetations, particularly by transthoracic echocardiography does not exclude endocarditis.