Echocardiogram Ie

Echocardiographic approach

<2%

Treat bacteremia; no echocardiography needed

2-4%

Obtain TTE

>5%

Proceed directly to TEE

It must be emphasized that echocardiography cannot distinguish between infective and noninfective or acute and chronic vegetations, or the causative organism. For these reasons, echo-cardiography alone should not be relied on to provide a definite diagnosis of IE.

It must be emphasized that echocardiography cannot distinguish between infective and noninfective or acute and chronic vegetations, or the causative organism. For these reasons, echo-cardiography alone should not be relied on to provide a definite diagnosis of IE.

Infective Endocarditis Echo
Fig. 15. These images are from a 76-yr-old woman with suspected endocarditis. The mobile vegetation (single arrows) was anterior to the anterior mitral valve leaflet. (Please see companion DVD for corresponding video.)
Echocardiography Images
Fig. 16. These images from a 64-yr-old male with active endocarditis show verrucous vegetations (arrows, A,B). Note the peri-valvular echolucent foci indicative of an aortic root abscess (arrows; C,D). (Please see companion DVD for corresponding video.)
Verrucous Endocarditis
Fig. 17. This undulating vegetation (arrow) attached to the pacer wire was an incidental finding in an otherwise normal patient.
Mitral Valve Intra Cardiac Echo

Fig. 18. These relatively large and highly mobile vegetations were visualized in the right heart chambers on both transthoracic (A) and transesophageal echocardiography (B). The patient's infected pacemaker was removed. (Please see companion DVD for corresponding video.)

Transesophageal Echocardiography

Fig. 18. These relatively large and highly mobile vegetations were visualized in the right heart chambers on both transthoracic (A) and transesophageal echocardiography (B). The patient's infected pacemaker was removed. (Please see companion DVD for corresponding video.)

Echocardiographic Characteristics

When both clinical presentation and blood culture evidence exist, typical echocardiographic features supporting IE include: (1) an oscillating intracardiac mass localized to a valve or intracardiac device, (2) intracardiac abscesses, (3) new partial dehiscence of a prosthetic valve, or (4) new or worsening valvular regurgitation.

Vegetations often appear as mobile echogenic masses attached to the valve, endocardial surface, or prosthetic materials within the heart and can present in a variety of shapes and sizes (Figs. 15-18; please see companion DVD for corresponding video for Figs. 15, 16, and 18). They frequently exhibit high frequency flutter or oscillations, with right-sided vegetations generally larger than left-sided ones. However, none of these features are pathognomonic for IE as they may exist separately or in conjunction with noninfectious causes. Correlation with clinical and microbial parameters is always warranted. Several differential diagnoses should be considered when confronted with mobile echogenic intracardiac masses (Table 3). In the absence of vegetations, new-onset valvular dysfunction on color flow Doppler interrogation may suggest IE.

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