Further examination of the body reveals the following gross lesions.

Microscopic evaluation of each of the lesions show essentially the same thing (use the virtual microscope to a typical lesion on the next page).

Do these finding fit with the diagnosis of bacterial endocarditis, and if so, how?

Would you expect to find similar lesions in the lungs?

Why are the lesions in the brain hemorrhagic?

These are examples of septic emboli that have broken off from the aortic valve vegetations and lodged downstream. The emboli are composed of bacteria, neutrophils and fibrin (much like the valve lesions). Since the vegetations are present on the aortic valve (left side of the heart) you would not expect to see septic emboli in the lungs (in contrast to the right-sided vegetations seen in IV drug users).

Classically, emboli to the brain are hemorrhagic, either because collateral vessels rupture because of transient pressure changes, or because the embolus dislodges, exposing necrotic brain to the full force of arterial pressure.

The virtual microscope shows septic emboli that have travelled to the heart muscle. In this patient this was a terminal even so there was no time to develop an inflammatory response.