Tricuspid valve avulsion.

A 71-year-old male with a medical history of sick sinus syndrome with dual-chamber pacemaker system implantation six years prior, and hypertension presented to the emergency department with complaints of generalized malaise, fever, and severe lower back pain. His evaluation was significant for a 2.3 cm × 1.2 cm epidural abscess, alongside methicillin- resistant staphylococcal bacteremia. He was started on intravenous vancomycin. A transthoracic echocardiogram was performed with the discovery of a 1.2 cm long vegetation in the upper right atrium attached to the pacemaker lead, an ejection fraction of 50％–55％, and no gross valvular abnormalities.