UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Brandon Parker

Posted: 7/26/2015 by Haney Mallemat, MD (Updated: 7/27/2015)
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Question

You are performing a cardiac ultrasound on a patient with a fever. Below is a parasternal long-axis, zoomed in on the aortic valve? What's the diagnosis?....careful, this is tricky.

Answer

Lambl's excrescences (LE)

Threadlike-projections that occur along the valve closure lines on the aortic side of the aortic valve; these are often confused for endocarditis
Most patients with LE are asymptomatic, however LE can break off the valve and cause embolic stroke
LE can sometimes be seen on TTE, but consider TEE if multiple embolic strokes have occurred without identifying a cause.
Patients without symptoms should be monitored for stroke. After an initial stroke, LE may be managed with anti-coagulation; patients experiencing multiple strokes may benefit from surgical debridement of the LE

References

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