Vegetations are common enough, but not so common when, as here, the vegetation is on the other side of the heart to the primary infection. On this transoesophageal echo, the aorta contains a metallic valvar prosthesis that is infected. There is an abscess cavity between the aortic root and the left atrial cavity. The infection has eroded the root on the right atrial side and a large vegetation (arrowed) has grown out into the atrial cavity.