Edgar Argulian
@argulian
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What is the pathology and the treatment? Hint: the ultrasound machine is not broken
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Uremic pericarditis with pericardial effusion and fibrinous strands, 2D TTE, short axis view
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In advanced cardiac amyloidosis with reduced ejection fraction, only the apex is contracting! 'Apical sparing' seen without fancy tools @ManiVannanheart
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A typical example of pseudodyskinesis due to hiatal hernia on an off-axis basal short axis view.
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An example of marked ventricular dyssynchrony due to conduction abnormality with remarkable inefficiency.
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Truly quadricuspid.
Seeing Quad! A real rarity (<0.05%) - quadricuspid aortic valve #echofirst @amerjohri @HeartDocSharon @RodrigoBagur @VLSorrellImages
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A large thrombus resting comfortably in the right atrial appendage. With all the hype about LAA, RAA is often ignored.
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Purulent pericarditis, short axis view below pap muscles. Note large effusion, partial adhesion and soft echo densities in the pericardial space
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A patient with severe chest pain and hypotension. What is the diagnosis?
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A patient with several weeks of intermittent chest pain, 3D TTE. What is the diagnosis?
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A patient is admitted to ICU with respiratory failure. The parasternal long axis view is shown. What is the finding?
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End-stage TTR cardiac amyloidosis with biventricular failure, TTE, short axis view. Occasionally, one image is diagnostic!
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Patient with heart failure and LBBB. Note dyssynchrony and apical rocking
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In patients with difficult parasternal windows, especially COPD, subcostal short axis is commonly a rescue. In this patient, note partial fusion of RCC and LCC, as well as good delineation of the pulmonic valve
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A large thrombus in the right atrium attached to a catheter, 3D TEE RA perspective. No hardware is benign!
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Outpatient with some exertional dyspnea for 5 weeks. Unspecified rheum disease. Asymptomatic at rest, BP 150/80, HR 93. IVC engorged.
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When RV is too large and tricuspid valve refuses to coapt, 3D TEE, dual perspective
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A patient with no coronary artery disease and prior ICD implant. What is the likely diagnosis?
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A patient with dyspnea. CW thru the mitral valve. What are the findings?
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A patient with known SLE presents with transient limb numbness. What are the findings?
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In this patient with severe right ventricular dysfunction due to lung disease, TAPSE measure at 1.8 cm. The annular motion is driven by the pulling effect of small, hyperdynamic left ventricle.
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Answer: PDA. Recognition of PDA in adults is based on the short axis view with proper PA visualization (shown) and the suprasternal view. Both can be challenging in adults if proper acquisition is not performed.
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Secondary mitral regurgitation, 3D TEE with high tissue transparency. Note jet asymmetry slightly favoring the medial aspect of the valve
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A patient with a long standing murmur. What is the likely pathology?
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Typical flow separation in the abdominal aorta in a patient with aortic dissection
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A patient with renal disease. Modified subcostal view is shown.
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Small jets of residual MR after a single clip implantation in a patient with secondary mitral regurgitation, 3D TEE, high tissue transparency
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Normal aortic valve, 3D TEE rendering with low tissue transparency. Note no dropout and crisp coaptation line
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Check out this challenging TEE probe advancement in a patient with mediastinal shift pre-mitral clip reported by Ishizu et al. For full case please go to:. @JGrapsa @JACCJournals
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An outpatient with non-cardiac symptoms. What is wrong with the tricuspid valve?
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Interatrial septal aneurysm with PFO. Note that the PFO opening is commonly best evaluated on TEE at the short axis view, 40-50 degrees
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Septal motion typical for right ventricular volume overload (caused by lead related TR) in the basal short axis view: note systolic rounding and diastolic flattening of the interventricular septum
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3D TEE tips: aortic valve. It is difficult to avoid dropout since aortic leaflets are thin, and beam alignment is not perpendicular. 1) Clean up 2D image and acquire the dataset using the short axis.2) Narrow the acquired volume, switch to spatial resolution from balanced.3)
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What is wrong with the wall motion in this attempted 2-chamber view?
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An outpatient with transient neurologic symptoms. What is the most likely diagnosis?
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A middle-age patient with dyspnea. How can history help in diagnosis?
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A large coaptation gap in a patient with secondary MR, 3D TEE, LV perspective. LV perspective is essential in assessing valve coaptation, jet exit and valve tenting in secondary MR patients
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Mitral annular calcification with mobile components in an elderly non-infected patient with a stroke, 3D TEE, left atrial perspective
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A young, active adult with a loud murmur. Modified PLAX shown. What do you expect on CW Doppler thru the lesion?
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'Twin' thrombi in the left atrium as seen from the roof of the left atrium in a patient with a hypercoagulable state, 3D TEE
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Typical doming of the bicuspid aortic valve in a patient with biventricular failure. This finding should raise strong suspicion of a bicuspid valve, even if the short axis views are inconclusive
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Occasionally one clip can tell the whole story. What are the findings and what is the diagnosis in this elderly patient?
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Upper esophageal view of the pulmonic valve on 2D TEE, fascinating but may be technically challenging
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A patient with dyspnea. Suprasternal view is obtained. 1/2
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A patient admitted after trauma. No prior cardiac history. What is unusual about this finding?
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Subaortic membrane causing severe calcification and immobility of the non-coronary aortic cusp due to chronic turbulence
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A patient with leg swelling. When color Doppler is obvious enough.
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A patient with exertional symptoms undergoes treadmill echo. 4CH view is shown. 1/2
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A patient with recent onset fever and shortness of breath. A suprasternal CW Doppler recording is shown. What explains the notching of the forward flow marked by arrows?
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Floppy and redundant mitral chords in a patient admitted for pneumonia. This should not be confused with systolic anterior motion of the mitral valve, which has hemodynamic significance
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A patient with aortic regurgitation, 2D TTE, zoomed long axis view. What is the causal mechanism?
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A patient with chest pain and normal coronaries, now hypotensive in the unit. Emergent echo is done. What is the diagnosis?
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Normal bileaflet mechanical mitral valve, 3D TEE, LA perspective
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Systolic anterior motion of an elongated, redundant anterior mitral leaflet, with septal contact, as seen on 3D TEE. Note high temporal resolution.
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An elderly patient admitted to critical care with respiratory failure. Attempted 4 chamber view. What is the diagnosis?
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A patient with progressive renal failure. Which spaces with effusion are seen?
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A patient with unexplained aortic dilation. A short axis view on 2D TTE is shown. What is the pathology?
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A patient with remote cancer history. 2D TTE, frame rate >100 fps. What is the finding?
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An apical thrombus in a patient with revascularized anterior MI on day 7 confirmed with contrast echo. Not seen on day 1. 1/2
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For all 3D lovers: severe extensive atherosclerosis of the descending aorta with a large mobile component
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Double trouble: severe AI and severe MR jets from an overhead left atrial perspective, 3D TEE, high tissue transparency
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A patient with dyspnea. Spectral Doppler recording thru LVOT. What are the abnormalities? Difficult but solvable
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A patient with renal disease, no evidence of infection 1/2
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An example of poor tricuspid leaflet coaptation due to tethering leading to secondary TR
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A young patient with syncope. In addition to other findings, a low, near apical attachment of the papillary muscle is seen in this off axis 4-chamber view. What is the relevance of this observation?
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Marked tethering of the posterior mitral leaflet with anterior leaflet override in a patient with non-ischemic dilated cardiomyopathy, the beauty of MPR
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Patient in ICU, what is the unifying diagnosis based on color M-mode in parasternal long axis view?
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A patient with renal disease and a prior myocardial infarction
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A young asymptomatic patient with a murmur as a child. Color Doppler unremarkable. What is the diagnosis?
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Mitral valve aneurysm (A2) post endocarditis with a discrete perforation, 3D TEE, dual volume layout (LA and LV)
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Patient with marked cardiomegaly and severe mitral regurgitation. What is the mechanism of MR?
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Extensive mitral annular calcification engulfing the posterior leaflet and medical commissure, 3D TEE, left atrial perspective
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From good, old pre-COVID days: classic Barlow's mitral valve disease with multi-scallop prolapse
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Stress cardiomyopathy with a single beat triplane acquisition. Note the temporal resolution!
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