Fig. 1

An ECG-gated cardiac CT angiogram in a 22-year-old female intravenous drug user with a bicuspid aortic valve, fever and a new murmur. (a) A coronal multiplanar reformat (MPR) of the aortic valve demonstrates a perforation (double arrow) in the posterior leaflet of the bicuspid aortic valve. (b) A 3-chamber MPR demonstrates periaortic soft tissue thickening posterior to the aortic root (arrow), extending inferiorly towards the anterior leaflet of the mitral valve (curved arrow), consistent with spread of infection to the intervalvular fibrous body. The patient underwent aortic and mitral valve replacement, and the infected valve tissue grew S. aureus. LA = left atrium; LV = left ventricle; Ao = ascending aorta; RA = right atrium; RV = right ventricle