Cover Image: Tissue Doppler imaging for better visualization of vegetations in a case of infective endocarditis
Dariusch Haghi, Theano Papavassiliu, and Tim Sueselbeck
I. Medical Department, University Hospital Mannheim, Mannheim, Germany
A 70-year-old man presented with progressive anorexia, malaise, and weight loss. Four months earlier he had undergone an extensive dental procedure. He had mild anaemia, leucocytosis, and elevated liver enzymes. Streptococcus gordonii was detected in several blood cultures. Transoesophageal echocardiography revealed degenerative changes of the aortic valve. A large vegetation could be identified on the non-coronary cusp (arrowhead in panel A), a second smaller vegetation was identified on the right coronary cusp (arrow in panel A). Better differentiation of the smaller vegetation from adjacent degenerative valvular changes could be achieved by means of tissue Doppler imaging (arrow in panel B). Compared with the surrounding tissue, freely oscillating vegetations have a different velocity and direction of motion; this incoherent motion is the reason for the observed phenomenon.
Figure legend
Panel A: A large vegetation is visualized on the non-coronary cusp (arrowhead) of the aortic valve. A smaller vegetation can be identified on the right coronary cusp (arrow).
Panel B: Tissue Doppler imaging can clearly differentiate both the larger (arrowhead) and the smaller (arrow) vegetation from adjacent cardiac structures.
LA = left atrium, LV = left ventricle.
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