Endocarditis echocardiography and ultrasound: Difference between revisions

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=== Echocardiography ===
=== Echocardiography ===
The goals of echocardiography in the patient with endocarditis include the following:<ref name="pmid23574121">{{cite journal| author=Hoen B, Duval X| title=Clinical practice. Infective endocarditis. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 15 | pages= 1425-33 | pmid=23574121 | doi=10.1056/NEJMcp1206782 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23574121}}</ref><ref name="pmid26373316">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ et al.| title=Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. | journal=Circulation | year= 2015 | volume= 132 | issue= 15 | pages= 1435-86 | pmid=26373316 | doi=10.1161/CIR.0000000000000296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26373316  }} </ref><ref name="endo"> Endocarditis. Wikipedia (2015). URL= https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015</ref>
The goals of [[echocardiography]] in the patient with [[endocarditis]] include the following:<ref name="pmid23574121">{{cite journal| author=Hoen B, Duval X| title=Clinical practice. Infective endocarditis. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 15 | pages= 1425-33 | pmid=23574121 | doi=10.1056/NEJMcp1206782 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23574121}}</ref><ref name="pmid26373316">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ et al.| title=Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. | journal=Circulation | year= 2015 | volume= 132 | issue= 15 | pages= 1435-86 | pmid=26373316 | doi=10.1161/CIR.0000000000000296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26373316  }} </ref><ref name="endo"> Endocarditis. Wikipedia (2015). URL= https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015</ref>


# Determine the presence, location and size of vegetations
# Determine the presence, location and size of [[Vegetation (pathology)|vegetations]]
# Assess the damage to the valve apparatus and determine the magnitude of [[regurgitation]], [[perforation]] or leak
# Assess the damage to the [[valve]] apparatus and determine the magnitude of [[regurgitation]], [[perforation]] or leak
# To assess the dimensions and function of the [[ventricle]](s)
# To assess the dimensions and function of the [[ventricle]](s)
# To identify any [[abscess]] formation
# To identify any [[abscess]] formation
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=== Echocardiographic Features in Infective Endocarditis===
=== Echocardiographic Features in Infective Endocarditis===
* Irregular [[echogenic mass]] attached to valve leaflet
* Irregular [[echogenic mass]] attached to valve leaflet
* The attachment of the vegetation is on the upstream side of the valve leaflet
* The attachment of the [[Vegetation (pathology)|vegetation]] is on the upstream side of the valve leaflet
* There is chaotic independent movement of the mass relative to the valve  
* There is chaotic independent movement of the mass relative to the valve  
* The minimum size of a vegetation that is identifiable on trans thoracic echocardiography is 3 mm and by transoesophageal echocardiography route is 2 mm.  
* The minimum size of a [[Vegetation (pathology)|vegetation]] that is identifiable on [[transthoracic echocardiography]] is 3 mm and by transoesophageal echocardiography route is 2 mm.
* With treatment and time, the vegetation shrinks and can become fibrosed or calcified. It may not disappear completely.
* With treatment and time, the [[Vegetation (pathology)|vegetation]] shrinks and can become fibrosed or [[Calcification|calcified]]. It may not disappear completely.
* Large vegetations occur with fungal endocarditis or ''[[Staphylococcus aureus]]'' endocarditis.  
* Large vegetations occur with fungal [[endocarditis]] or ''[[Staphylococcus aureus]]'' [[endocarditis]].
* The hemodynamic effects are mostly due to valvular [[regurgitation]] as a result of valve destruction.
* The hemodynamic effects are mostly due to valvular [[regurgitation]] as a result of [[valve]] destruction.


'''The valve and the surrounding anatomy should be carefully inspected for the following complications:'''
'''The valve and the surrounding anatomy should be carefully inspected for the following complications:'''

Revision as of 20:24, 4 March 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Echocardiography may be diagnostic of endocarditis. Echocardiography allows detection of microbial vegetations and the degree of valvular dysfunction. Findings on transthoracic and transesophageal echocardiogram diagnostic of endocarditis include vegetations, valvular regurgitation, pseudoaneurysms, paravalvular abscess, and fistulas. The role of electrocardiography has been addressed in clinical practice guidelines from theAmerican Heart Association, with endorsement by the Infectious Diseases Society of America, have been updated in 2015.

Echocardiography/Ultrasound

Echocardiography

The goals of echocardiography in the patient with endocarditis include the following:[1][2][3]

  1. Determine the presence, location and size of vegetations
  2. Assess the damage to the valve apparatus and determine the magnitude of regurgitation, perforation or leak
  3. To assess the dimensions and function of the ventricle(s)
  4. To identify any abscess formation
  5. To determine the need for surgical intervention

Echocardiographic Features in Infective Endocarditis

The valve and the surrounding anatomy should be carefully inspected for the following complications:

  • Fistula
  • Perforation
  • Prosthetic dehiscence
  • Aneurysm
  • Vegetations
  • Valve ulcers or erosions
  • Rupture of chordaes
  • Endocardial jet lesions
  • Flail leaflets or cusps
  • Abscess formation (annular and ring)

Transesophageal Echocardiography (TEE) vs. Transthoracic Ehcocardiography (TTE)

In general, transthoracic echocardiography (TTE) is often adequate for the diagnosis of infective endocarditis in cases where cardiac structures-of-interest are well visualized. The transthoracic echocardiogram has a sensitivity and specificity of approximately 65% and 95% if the echocardiographer believes there is 'probabable' or 'almost certain' evidence of endocarditis.[4][5]

Specific situations where transesophageal echocardiography (TEE) is preferred over TTE include:

  • The presence of a prosthetic valve
  • Poor transthoracic views
  • Continuing sepsis despite adequate antibiotic therapy
  • New PR prolongation
  • No signs of endocarditis on transthoracic echocardiography, but high clinical suspicion
  • Suspected periannular complications
  • Children with complex congenital cardiac lesions
  • Patients with S. Aureus caused bacteremia and pre-existing valvular abnormalities that make TTE interpretation more difficult (e.g. calcific aortic stenosis).

Video Examples

{{#ev:youtube|v6VGccGETQA}}

Other Imaging Findings

Various radionuclide scans using, for example, gallium Ga 67–tagged white cells and indium In 111–tagged white cells, have proven to be of little use in diagnosing IE. Radionuclide scans of the spleen are useful to help rule out a splenic abscess, which is a cause of bacteremia that is refractory to antibiotic therapy.

Sources

  • 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease [6]

References

  1. Hoen B, Duval X (2013). "Clinical practice. Infective endocarditis". N Engl J Med. 368 (15): 1425–33. doi:10.1056/NEJMcp1206782. PMID 23574121.
  2. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ; et al. (2015). "Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association". Circulation. 132 (15): 1435–86. doi:10.1161/CIR.0000000000000296. PMID 26373316.
  3. Endocarditis. Wikipedia (2015). URL= https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015
  4. Shively B, Gurule F, Roldan C, Leggett J, Schiller N (1991). "Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis". J Am Coll Cardiol. 18 (2): 391–7. PMID 1856406.
  5. Erbel R, Rohmann S, Drexler M, Mohr-Kahaly S, Gerharz C, Iversen S, Oelert H, Meyer J (1988). "Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach. A prospective study". Eur Heart J. 9 (1): 43–53. PMID 3345769.
  6. Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

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