HORIZONTAL PLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY MAY BE FALSE-NEGATIVE FOR LARGE TRICUSPID VEGETATIONS

A 37-year-old man was admitted to the hospital with fever. Because of a history of intravenous drug abuse, and a picture consistent with sep tic pulmonary emboli, right-sided endocarditis was suspected. However, transthoracic echocardiography did not reveal any vegetations. Transe sophageal echocardiography was therefore done, and excellent visualiza tion of the tricuspid valve with the horizontal plane view showed what appeared to be a normal tricuspid valve. However, the vertical plane image clearly showed a Large tricuspid vegetation. This case illustrat es the advantage of the biplane transesophageal transducer, as the dia gnosis would have been missed with a standard single plane probe.