Thread by @dr_benoy_n_shah

**VALVE CASE OF THE WEEK**

In our hospital, we have seen 2 patients over the past 3 years that presented with acute heart failure and who had severe AR on echo with large, characteristic masses on the AV. This week's poll is simply... what do you think these masses are? (1)

Patient 1 - Female, early 60s, no major PMHx, admitted with 2 weeks worsening SOB and palpitations. No fever. In heart failure, BP 110mmHg systolic. AR murmur. Normal white cell count & near normal CRP on bloods. TTE below...zoomed PLAX view of AV (2)

Here is a TOE view...(3)

Patient 2 - Male, 70s, similar story. Also had normal inflammatory markers. Also had a long, echobright mass on AV...here is PLAX view...(4)

And here is AP5Ch view...(5)

Both patients had 2 sets of blood cultures that were negative after 4 days growth.

So... what do you think?! If it's a tumour, what sort? If vegetation, which organism? Thrombus? Artefact??! Poll on next message! (6)

What do you think these masses are?

@BSEcho @ASE360 @escardio @echo_stepbystep @EchoCases @TheBJCA @BJCA_Women_LTFT @BJCAstarter @global_wic @WessexSpRs @heartdockumar @cardiacLucy @nat_echo @RobChamb87 @DrDanAugustine @arh_cardio @FGraziani_Grace @NMerke @iamritu @purviparwani @rachkataria @HJarrett_MD @brwcole

@SineadHughes19 @scrivsy85 @Doc_Tiger @vitormweaverBSE @RODRIGOVISCONT1 @shaunrobinson02 @fpmorcerf @MadalinaGarbi @hannahcvimaging @hannahzr @dorsetcardio @DrChrisMcAloon @dr_chrisallen @iceman_ex @LynnGreigMiller @jdrwilcox
#ACCFIT #EACVI #echofirst #cardiotwitter #MedTwitter

@M_Pompeu_Sa_MD @BirkhoelzerS @Dr_CPeter

Apologies to anyone I forgot to tag! Please RT & share. As usual, answer tomorrow! 😁

Ok, so here's the answer! Interesting poll results!

Both patients went to theatre; surgeons found masses on all 3 cusps of the AV in both cases.

PCR analysis of the native leaflet tissue revealed...Tropheryma whipplei! So...Whipple's endocarditis!

Why present this case?

Because studies suggest it is an increasingly encountered cause of culture negative endocarditis. The aortic valve is most commonly involved and a lengthy antibiotic treatment course is required...both patients had 6 weeks IV antibiotics and then 1 year of oral treatment too!

The masses are very characteristic...long, highly mobile and very echobright. So, if you see such masses again, think Whipple's!
We're writing these cases up just now, so pls don't steal the images (yet)! 🤣

New case next week! 😁

@BrHeartValveSoc