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6-year-old castrated male Rhodesian Ridgeback

September 1, 2015

Tachypnea, weakness. Cardiac arrhythmias noted. Echocardiogram and abdominal ultrasound requested for workup.

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  • Successful candidates correctly identified the structures and chambers imaged.
  • Thickening of the noncoronary cusp of the aortic valve was correctly identified on both short and long axis views (Figs. 1,2, below).
  • A regurgitant jet was identified in the left five chamber view (Fig. 3) and in the long axis left ventricular outflow tract view (Fig. 4).  Unsuccessful candidates identified the valve in the long axis left ventricular outflow tract view as the mitral valve with a regurgitant jet.  The size and shape of the valve is not compatible with the mitral valve and recognition of the aortic sinus helps identify the structure (Fig. 3).
  • Successful candidates identified the remaining cardiac structures as normal.  Normal structures identified as abnormal resulted in points deducted.  No deduction was made if mild left ventricular enlargement was suggested as no measurements were provided for definitive evaluation.
  • Most candidates correctly identified the focal area of hypoechoic lacey splenic parenchyma between sections of normal spleen (Fig. 5).  Color flow Doppler indicated lack of normal blood flow in the hypoechoic lesion.
  • exam2015-us2_2
    Figure 1 - Right parasternal short axis AO view - Thickened noncoronary cusp of the aortic valve (arrow).
  • exam2015-us2_3
    Figure 2 - Left apical five-chamber view - Thickened noncoronary cusp of the aortic valve (arrow).
  • exam2015-us2_4
    Figure 3 - Left five-chamber view with Doppler - Regurgitant jet into left ventricle during diastole (arrow).
  • exam2015-us2_5
    Figure 4 - Long axis left ventricular outflow tract with Doppler - Regurgitant jet into left ventricle (LV) during diastole.
  • exam2015-us2_6
    Figure 5 - Splenic infarct (I) and normal spleen (S).
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  • The correct conclusion is vegetative aortic valve endocarditis with insufficiency.
  • The splenic change is indicative of focal splenic infarction likely associated with emboli from the aortic valve endocarditis.

Medical management of vegetative endocarditis with appropriate antibiotics and treatment for congestive left heart failure is indicated.  The candidate was expected to suggest blood and urine cultures as part of the case management.