Cardiac Point of Care Ultrasound (POCUS) Used to Diagnose Infective Endocarditis Following Multiple Negative Echocardiograms

TL;DR

A case shows how cardiac point of care ultrasound (POCUS) can detect infective endocarditis when traditional echocardiograms fail.

Contribution

Demonstrates the diagnostic utility of advanced cardiac POCUS in a case with negative TTE and TEE results.

Findings

POCUS identified a vegetation on the aortic valve missed by multiple echocardiograms.

Findings were later confirmed by TTE and TEE, validating POCUS accuracy.

Suggests POCUS could improve diagnostic accuracy and outcomes in critical patients.

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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