Key result
Transgastric 2D and 3D TEE detects pulmonary valve vegetation when acoustic shadowing obscures standard views.
Why the study?
Isolated pulmonary valve endocarditis is rare and diagnostically challenging, often lacking typical clinical findings and being difficult to visualize with standard echocardiographic views.
Case Report (n=1)
No
Transgastric 3D TEE is a valuable advanced imaging technique for diagnosing isolated pulmonary valve endocarditis when conventional echocardiographic views are inconclusive.
May prompt consideration of isolated PVE in refractory bacteremia on hemodialysis; leaves open optimal diagnostic protocols.
Isolated pulmonary valve endocarditis (PVE) is a rare and diagnostically challenging form of right-sided infective endocarditis, often lacking the typical findings seen with left-sided or tricuspid valve involvement. We describe an 83-year-old man with end-stage renal disease on hemodialysis, who developed persistent Staphylococcus aureus bacteremia despite appropriate antibiotics and catheter exchange. Standard diagnostic methods, including physical examination, laboratory tests, and transthoracic echocardiography, were unremarkable. Initial transesophageal echocardiography (TEE) with conventional views was limited by acoustic shadowing. Ultimately, transgastric two-dimensional (2D) and three-dimensional (3D) TEE imaging revealed vegetation on the pulmonary valve, leading to the diagnosis. The patient improved with ongoing therapy, and further imaging was deferred by agreement. This case highlights the need to consider isolated PVE in patients with persistent bacteremia and intravascular devices, even without classic risk factors. It also emphasizes the value of advanced imaging, particularly transgastric 3D TEE, for detailed assessment of the pulmonary valve when conventional studies are inconclusive. A multidisciplinary approach involving infectious diseases, nephrology, and cardiology is essential for prompt diagnosis and effective management. In summary, comprehensive imaging and a high index of suspicion are critical for identifying isolated PVE, which should remain a differential diagnosis in select high-risk patients with unexplained bacteremia.
No takes yet. Share an insight, caveat, or question.
Rodriguez et al. (2026) conducted a case report in Isolated pulmonary valve endocarditis (n=1). Transgastric 2D and 3D transesophageal echocardiography vs. Standard echocardiographic views was evaluated on Detection of pulmonary valve vegetation. Transgastric 2D and 3D transesophageal echocardiography successfully identified a vegetation on the pulmonary valve when standard echocardiographic views were inconclusive due to acoustic shadowing.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: