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• W2260943669 abstract "A 49-year-old-man with a history of end-stage renal disease, hypertension, deep venous thrombosis, and intravenous drug use presented to the emergency department with acute respiratory distress. The patient reported worsening dyspnea on exertion and chest pain for 1 week. On evaluation, initial vital signs were blood pressure 203/130 mm Hg, pulse 119 beats/min, respiration 28 breaths/min, oxygen saturation 100% on a nonrebreather mask, and temperature 38.4°C. The patient was alert and in moderate respiratory distress, with bilateral expiratory rales on auscultation; cardiovascular examination revealed tachycardia and 2+ pitting edema in bilateral lower extremities. The ECG revealed sinus tachycardia with left-sided ventricular hypertrophy without any ST-wave abnormalities. A portable chest radiograph was ordered and bedside point-of-care ultrasonography was immediately performed. The apical echocardiographic image can be seen in Figures 1 and 2. The echocardiography clip can been seen in Video 1 (available online at http://www.annemergmed.com).Figure 2Echogenic mobile oscillating mass on tricuspid valve.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Tricuspid vegetation concerning for infective endocarditis. The patient’s diagnosis was confirmed by 2 recent blood cultures positive for Streptococcus viridians. Vegetations on echocardiography are classically observed as a discrete echogenic oscillating material that is adherent to the valve leaflet but different in character, with an independent motion from the valve.1Armstrong W. Ryan T. Feigenbaum’s Echocardiography.7th ed. Lippincott Williams & Wilkins, Philadelphia PA2010Google Scholar, 2Habib G. Bandano L. Tribuouilloy C. et al.Recommendations for the practice of echocardiography in infective endocarditis.Eur J Echocardiogr. 2010; 11: 202-219Crossref PubMed Scopus (352) Google Scholar Cardiac vegetations tend to be located on the low-pressure side of the valve, with a gray echogenicity similar to that of myocardium.2Habib G. Bandano L. Tribuouilloy C. et al.Recommendations for the practice of echocardiography in infective endocarditis.Eur J Echocardiogr. 2010; 11: 202-219Crossref PubMed Scopus (352) Google Scholar Transthoracic echocardiography has a reported sensitivity of 60% to 70% for detection of vegetations.2Habib G. Bandano L. Tribuouilloy C. et al.Recommendations for the practice of echocardiography in infective endocarditis.Eur J Echocardiogr. 2010; 11: 202-219Crossref PubMed Scopus (352) Google Scholar However, the sensitivity of transthoracic echocardiography for tricuspid vegetations is thought to be significantly higher because the tricuspid valve is well visualized from the transthoracic windows and right-sided vegetations tend to be larger.1Armstrong W. Ryan T. Feigenbaum’s Echocardiography.7th ed. Lippincott Williams & Wilkins, Philadelphia PA2010Google Scholar, 2Habib G. Bandano L. Tribuouilloy C. et al.Recommendations for the practice of echocardiography in infective endocarditis.Eur J Echocardiogr. 2010; 11: 202-219Crossref PubMed Scopus (352) Google Scholar, 3Humpl T. McCrindle B. Smallhorn J. The relative roles of transthoracic compared with transesophageal echocardiography in children with suspected infective endocarditis.J Am Coll Cardiol. 2003; 41: 2068-2071Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJhYTZiM2U1MDJkZTc3NDBkYzg0MmI3YjRiYmVjM2MyYSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4Mzg5MDc1fQ.Du0q0APRUqdBe7kOpQAXo3895QDZEswhvQc-968dTUCDSsj5mDGcH6sWVLxp2V3OeKurz2LjhIvukW_j9qDJdVcQiZn_Fb3o2vjwK76JX7BSB4zt4nZjF61AoVQDimOORBzHMdYhheKguPJGbaR0y-8GurynNBMCytUZB6Ih3AoEa0Xfjb_x1Oy_MqoTJlDBx0v42VtTHMnWXy1RCTKc1ZoDDYYbZY3yrf5iSk_FREqyvSOWhXYcFCaoCI1LIzZoo0w67jJ8gBPQkDDT-N3XRn6ZwuC-D_RxknJ_qJCnik2EBf0_avfEuBXBGXUmc5Oerg5wEAXA1T_xufC0cZWaOQ Download .mp4 (1.05 MB) Help with .mp4 files Video E1" @default.
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• W2260943669 title "Man With Acute Respiratory Distress" @default.
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• W2260943669 doi "https://doi.org/10.1016/j.annemergmed.2015.05.007" @default.
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