Ultrasound for Critical Care Physicians: Right Diagnosis, Wrong Place

Friday, October 4, 2013 at 8:00AM
Rick Robbins, M.D. in Enterococcus faecalis, aortic valve replacement, bacteremia, diastolic murmur, endocarditis, heart, mitral valve, prosthetic valve, ultrasound

The patient was a 76 year old man, with a history of a prosthetic aortic valve (aortic stenosis) and chronic myelogenous leukemia.  He presented with fever and cough, and was found to have pneumonia with Klebsiella pneumonia cultured from a BAL. However, he also had persistent Enterococcus faecalis bacteremia and a new 3/6 diastolic murmur. 

An ultrasound of the heart was performed (Figures 1 and 2).

Figure 1. Parasternal long axis view of the heart.

 

Figure 2. Four chamber view of the heart.

 

Which of the following is the likely diagnosis?

1. Aortic dissection
2. Aortic valve endocarditis
3. Displacement of the aortic valve
4. Mitral valve endocarditis
5. Tricuspid endocarditis

Reference as: Raschke RA. Ultrasound for critical care physicians: right diagnosis, wrong place. Southwest J Pulm Crit Care. 2013;7(4):232-5. doi: http://dx.doi.org/10.13175/swjpcc123-13 PDF

 

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).