Article Text

A dairy worker with fever and an abnormal echocardiogram
  1. Gopal Chandra Ghosh,
  2. Lijo Varghese,
  3. Viji Samuel Thomson
  1. Department of Cardiology, Christian Medical College and Hospital, Vellore, India
  1. Correspondence to Dr Gopal Chandra Ghosh, Department of Cardiology, Room No. 310, Hospital Annexe, Christian Medical College and Hospital campus, Vellore, India; gcghosh86{at}


Description of the case A 38-year-old male presented with history of progressively increasing dyspnoea of 25 days duration. He gave history of low -grade fever associated with malaise and weight loss over the preceding 6 months. He worked in the dairy industry in the Middle East and returned to India owing to his illness. On clinical examination, he was found to be tachypneic and cachectic. Jugular venous pressure was raised with a prominent ‘a’ wave. There was a short early diastolic murmur over the aortic area. His blood investigations, including renal and liver function tests, were normal. Three sets of blood cultures were sterile. Two-dimensional trans-thoracic and trans-oesophageal echocardiography revealed thickened bicuspid aortic valve cusps, with moderate eccentric aortic regurgitation and an abnormal structure posterior to the left ventricular outflow tract and aorta (figure 1A–C). A small vegetation was seen attached to the fused right–left aortic cusp (supplementary figure 1). The patient was started on appropriate intravenous antibiotics and antifailure medications, and was referred for early surgical treatment.

Figure 1

(A) Transthoracic echocardiography parasternal long axis view. (B) Transesophageal echocardiography (mid esophageal level) long axis view. (C) Transthoracic echocardiography parasternal short axis view.

Supplementary Material

Supplementary Figure 1

Question Identify the structure depicted in the images (figure 1A–C).

Answer options:

  1. Cor triatriatum

  2. Aortic dissection

  3. Left atrial pseudoaneurysm

  4. Pseudoaneurysm of the mitral aortic inter-valvular fibrosa

  5. Aortic root abscess.

  • Infective endocarditis
  • Brucellosis
  • Pseudoaneurysm
  • Aortic valve insufficiency
  • Color Doppler echocardiography

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  • Contributors All the authors were involved in the clinical management of the patients. GCG and LV drafted, and VST revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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