CASE PRESENTATION: An 18 year old female presented with pleuritic chest pain, shortness of breath and fever. She was diagnosed 6 weeks earlier with group B streptococcus right-sided endocarditis following a dilatation and curettage procedure/Mirena intra-uterine device insertion. Despite medical management with IV antibiotics, her clinical status was deteriorating. A computed tomography scan of the chest demonstrated a large filling defect in the distal right pulmonary artery, with involvement of the interlobar artery and segmental branches of the right middle, right lower, and left lower lobes. A trans-thoracic echocardiogram revealed an increased PASP at 46mmHg and the disappearance of 2 vegetations (18.3x15.6mm and 17.6x9.3mm previously seen on her tricuspid valve). Her Troponin-I level was elevated at 3.41 (Normal range ≤0.04). She was brought to the OR and underwent a right pulmonary endarterectomy with removal of occlusive material. Pathology of the excised thromboembolism demonstrated thrombus and purulent exudate within an acutely inflamed arterial wall. She was placed on 6 weeks of additional antibiotic therapy and 6 months of oral anticoagulation. At follow up 6 weeks post-operation, she was clinically well with no signs of ongoing sepsis or recurrent emboli.