An aortic periannular abscess (PA) is a critical consequence of infective endocarditis (IE). In our case report, the patient’s clinical symptoms were only fever, cough, and shortness of breath. Then he was diagnosed with aortic PA, which was overlooked in the initial transthoracic echocardiography (TTE) assessment but later identified through transesophageal echocardiography (TEE). The patient underwent surgery immediately and recovered well. This case underscores the importance of TEE in revealing small, yet critical, intracardiac lesions that may be missed by TTE.