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Cardiac Point of Care Ultrasound (POCUS) Used to Diagnose Infective Endocarditis Following Multiple Negative
Adriano Sanjuan1, Daniel S Brenner2, Heather Andrade3
1Internal Medicine Residency Program, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Advanced cardiac point of care ultrasound (POCUS) successfully diagnosed infective endocarditis in a patient with negative initial echocardiograms. This highlights POCUS
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Imaging
Background:
- Infective endocarditis (IE) diagnosis relies on modified Duke's criteria, often involving echocardiography.
- Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) can yield inconclusive results in up to 30% of IE cases.
Observation:
- A 68-year-old male with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia presented with recurrent fevers.
- Multiple conventional echocardiograms failed to detect valvular vegetations.
- An advanced cardiac point of care ultrasound (POCUS) examination identified an aortic valve vegetation.
Findings:
- The POCUS finding was subsequently confirmed by TTE and TEE.
- This case demonstrates the diagnostic utility of advanced cardiac POCUS in IE when initial echocardiograms are negative.
Implications:
- Advanced cardiac POCUS may improve diagnostic accuracy and patient outcomes for infective endocarditis.
- Integrating POCUS into critical care workflows warrants consideration.
- Expanding intensivist proficiency in advanced cardiac POCUS is important for its effective use.
Abstract:
Infective endocarditis (IE) is a life-threatening condition often diagnosed using the modified Duke's criteria, including bacteremia and pathognomonic echocardiographic findings. However, up to 30% of cases yield inconclusive results with transthoracic echocardiograms (TTE) or transesophageal echocardiograms (TEE). We present a case of a 68-year-old man with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and recurrent fevers, in which multiple echocardiograms failed to detect valvular vegetations. However, an advanced cardiac point of care ultrasound (POCUS) examination identified a vegetation on the aortic valve, later confirmed by TTE and TEE. Although generalization is limited due to operator expertise and patient characteristics, this case demonstrates the utility of advanced cardiac POCUS in diagnosing IE in critically ill patients with negative initial echocardiograms. Incorporating advanced cardiac POCUS into routine diagnostic workflows may improve diagnostic accuracy and patient outcomes. Increasing use of advanced cardiac POCUS also highlights the importance of expanding proficiency among intensivists.
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