The pitfalls of transthoracic echocardiography - A case of eustachian valve endocarditis

A case of infective endocarditis involving the vestigial eustachian valve i s presented and the available English medical literature is reviewed. Only 5 prior cases have been reported: 4 of those required transesophageal echoc ardiography for diagnosis, and the other was Found at autopsy. This clinica l entity is routinely missed on transthoracic echocardiography. Injection d rug use is a common predisposing Factor, and Staphylococcus aureus is the m ost commonly identified organism. This report broadens the differential diagnosis of endovascular infections in injection drug users and highlights the importance of transesophageal ec hocardiography For diagnosis in selected patients.