A beautiful example of vascular anomalies in a patient with congenital heart disease.

Patient history positive for known ventricular septal defect (VSD) - perimembranous restrictive type - and patent ductus arteriosus Botalli (PSD), the latter been corrected in early childhood.

Blood cultures turned out to be positive for streptococcus spp, causing endocarditis adjacent to VSD, proven by trans esophageal echocardiography and treated by 6 weeks of antibiotics.

Coincidental skeletal findings are consistent with ankylosing spondylitis.