Complex endocarditis in an immunocompromised host: the role of three-dimensional echocardiography

This case report emphasizes the role of different echocardiography imaging modalities, including three-dimensional imaging, in defining the invasive complications of infective endocarditis. We report the case of an immunocompromised patient who was admitted for stroke workup and found to have complex culture negative endocarditis. Echocardiography showed an aortic root abscess and a large intramyocardial, echogenic area with central liquefaction, suggestive of an intramyocardial abscess. An aneurysm of the mitral-aortic intervalvular fibrosa was also visualized along with a prominent aneurysm of the right coronary cusp, best visualized with three-dimensional imaging. Our patient was considered inoperable and died of this illness 2 weeks later.