Pulmonary valve endocarditis: always look on the (B)right side!

Right-sided infective endocarditis (IE) constitutes a distinct subset within the spectrum of endocarditis, accounting for a smaller fraction of cases than left-sided IE. Despite its relatively lower incidence, right-sided IE poses unique challenges in both diagnosis and treatment. Unlike left-sided IE, which primarily affects the mitral and aortic valves, right-sided IE predominantly affects the tricuspid valve (TV) and rarely the pulmonary valve (PV) and is often associated with intravenous drug use (IVDU) and intracardiac devices as prevalent predisposing factors. Diagnostic imaging, particularly echocardiography, plays a central role in the timely detection and characterization of right-sided IE. However, anatomical factors may complicate imaging and necessitate the use of adjunctive modalities for accurate diagnosis and also to search for the source of systemic embolism. In this context, we present an interesting clinical case of PV IE, highlighting the diagnostic challenges, therapeutic considerations, and clinical outcomes associated with this condition.