In rheumatic hea disease, infective endocarditis is detected by echocardiogram and the largest vegetations seen are due to -

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:161-162 Acute infective endocarditis: Caused by highly virulent organisms mainly S. aureus (20-30%), seeding a previously normal valve 2D Echo * The smallest size of vegetation that can be picked up by echo is 2 mm. * Transoesophageal echocardiography is more sensitive in detecting vegetations in the aoic valve (90%) and mitral valve (100%) than transthoracic echocardiography