Be sure to check out the absolutely beautiful 2D & 3D echo images in this
@CASEfromASE
report from Columbia.
Then, compare echo to specimens obtained at surgery:
Bonus Q (before reading CASE)?
A. Myxoma
B. Thrombus
C. Sarcoma
D. Endocarditis
#JADEL
Just dropped
@CASEfromASE
This is MUST WATCHED TV!
You simply MUST check out this CASE:
Teaching point:
Be aware of risk VA-ECMO-related aortic stasis!
@ASE360
#JADEL
This is one of the most important videos I have ever posted... so, don't be fooled (read CASE details, especially if you guessed it wrong)!
36-yr old man with cardiac arrest:
A. Thrombus post-STEMI
B. Loffler's
C. Tumor
D. Congenital finding
@CASEfromASE
@ASE360
#JADEL
To cardiovert or not- that is the Q!
Dog-Ear view only shows smoke!
Never stop here- keep looking!
The LAA is really complex and a CLOT may be hidden!
@ASE360
@CASEfromASE
OK- here we go!
My first
#JADEL
case for 2021- hope you enjoy it.
Try to guess what the
#echofirst
image will look like based upon the pathognomonic ECG tracing!
Did you guess correctly?
@ASE360
@CASEfromASE
#JADIL
Here's the
@VLSorrellImages
Just Another Day in the Imaging Lab case of the day. Enjoy this wonderfully illustrated secundum ASD with in-plane phase contrast and color-mapping.
@SCMRorg
#JADEL
Today's
@CASEfromASE
must read:
Q. What in the world is going on in the right heart?
A. Severe RVH
B. HOCM
C. Loculated hematoma
D. Myocardial metastasis
E. Retained post-op gauze
@ASE360
#JADEL
New from
@CASEfromASE
:
20yr-old man w/ dyspnea, chills, anemia & possible TIA in history:
A. Lymphoma
B. Endocarditis
C. Thrombus
D. Myxoma
E. Other
Read details (with M-mode, TEE, histopathology):
@ASE360
@JournalASEcho
Does everyone have the same “quality paradox” as me?
“The worse the LV function- the better the image quality”!
Must be an ‘acoustic mismatch’ physical property...
@ASE360
#JADEL
#JADEL
With echo, you can only diagnose what you’ve seen before ... so never forget this case (anomalous LCfx coronary arising from the RCA) with a retroaortic (benign) course. Not uncommon.
@ASE360
#JADEL
Hot off the
@CASEfromASE
presses:
How good are your echo skills?
Q. What is the mobile mass in the right heart of this 22yr old (with continuous murmur)?
A Blood cyst
B Endocarditis
C Ruptured SOV aneurysm
D Chiari network
Answer here:
@ASE360
Just in CASE you've never seen this before:
What do YOU see in the LA?
A. catheter
B. leaflet
C. clot
D. contrast
E. other (tell us)
92W had an unusual complication during TAVI:
@ASE360
@CASEfromASE
#JADEL
@ASE360
Have you ever asked yourself WHY you would consider ‘triple’ Rx (DAPT + warfarin) after PCI for massive LAD STEMI w/ small apical clot noted?
See below for 10-day natural history of DAPT only (N=1).
TOP row = OLD
BOTTOM = 10 days later
#JADEL
Can you Unlock the CASE: a fun, interactive case-based skills challenge on the
@CASEfromASE
homepage:
What is the arrow pointing to in 68M with CP?
A. Anom COR artery
B. Unroofed COR sinus
C. Artifact
D. Fistula
E. Calcification
@ASE360
#JADEL
Some echo's are nearly pathognomonic as recently shown in
@CASEfromASE
Q. 7 yr boy; fever, fatigue, weight loss
A. Loeffler endocarditis
B. Infiltrative CM
C. Hypertrophic CM
D. Dilated CM with clot
E. Other
@ASE360
@JournalASEcho
#JADEL
Although I've been on consults this week, I've enjoyed reading the collection of new reports in
@CASEfromASE
Here's the latest:
Before reading, can you guess what's going on here?
A. Endocarditis
B. Trauma
C. Iatrogenic
D. Clot in PFO
Preparing for echo boards? What’s the vertical, mobile, bright line at 12:00o’clock?
@ASE360
A. Falciform ligament
B. Catheter
C. Thrombus
D. Fibrin stranding
E. Not enough info
Latest in-press from
@CASEfromASE
Here's something you DON'T see everyday...
... something I am calling NOT
#JADEL
!
42M with CP, dyspnea, and AMS:
You'll want to take 5 minutes to read more here:
@ASE360
#JADEL
Here’s an ‘old-school’ unusual finding on AV M-mode. Can you “see” the pathology before the 2D?
A. Endocarditis
B. HOCM
C. BAV
D. Low flow
E. Something else
@CASEfromASE
@ASE360
Coming Soon...
#EchoFlorida22
#Oktoberbest22
I will be presenting Breakout Cases from CASE...
here's a sample:
Q. What is the most likely "I" to cause this?
A. Inherent
B. Infection
C. Inflammation
D. Ischemia
E. I don't know
Q. How do you have fun with your 90yr old mum?
A. Sneak a Sunflower seed into her Rose Garden when she’s not looking!
Brings a smile to the entire neighbourhood
Here’s my reminder to always sweep through the apex in search of clots- otherwise, a dilated dysfunctional LV may hide a surprise for you!
#JADEL
#echofirst
@ASE360
#JADEL
Me (at national lecture): “Automatic border detection, AI & GLS are changing how we practice echocardiography!”
Me (today, in lab, follow up chemotoxic patient): “Hmmmm… I may need to modify my slides”
Universal Definition of HEART FAILURE!
You heard it here first:
@ASE360
#ASE2021
#EchoAtHome
Finally- now only if our EMR / Coders will learn the same: Spread The Word!
#JADEL
@ASE360
Remember, the study is never complete without looking at the Aorta... never quit prematurely!
This TEE was pre-DCCV for AFib (high grade Aortic debris is really common in AF)
Just dropped in CASE
@CASEfromASE
:
Once again,
@rajdoc2005
gives us some insight into his incredible 3DE imaging skills. Great transillumination TEE quality of a rare finding... in a 57M with severe AR & LV dilation/dysfunction.
Read CASE details here:
#JADEL
Saw this study in 25yo and immediately phoned re: high risk for Sudden Death (IVS = 33mm).
They said: “Good call- had VF arrest last year.”
Follow thread for more clips
@ASE360
Here’s a small LV cleft - these are often normal variants & found in 5% general population.
Should exclude HCM (without LVH) & not misinterpret as Cong diverticulum or aneurysm.
@SCMRorg
#JADIL
#JADEL
Check out the latest multi-modality CV Imaging report from
@CASEfromASE
with 2D TTE, 3D TEE, CCT, PET & pathology:
Impressive mass:
Is it thrombus, infection, benign or malignant tumor? Where is it attached? Did PET help?
@ASE360
Learn through Twitter: did everyone already know this?
I admit it - I did not!
Basal IVS LGE may reflect septal perforator (not to be confused with DCM midwall fibrosis):
@Heart_SCCT
@SCMRorg
#EchoQOD
#EchoBaordsPrep
@ASE360
Based upon the single image provided, which patient fits best?
A. 30F with Trisomy 21
B. 70M with stroke
C. 60M, severe COPD & right arm injection
D. 80F, chronic PAH and left arm injection
E. 20F asymptomatic with persistent Left SVC
Here's my
#JADEL
case of the day...
Who needs color flow Doppler?
Young man with right heart failure & PH. Tricuspid annulus 60mm; RVSP >110mmHg; RA volume >450ml.
Have a great weekend everyone!
@ASE360
@CASEfromASE
Twitter, like all SM forums, has huge diversity of opinions.
I have a simple goal: >95% agreement.
What is the LV systolic function?
A. normal
B. mildly reduced
C. moderately reduced
D. severely reduced
E. must have more info
@ASE360
One of my former
#naughtyfellows
sent me this with the following question:
How come you never showed me this when I was training?
My answer: Because I never saw anything like this B4!
#echofirst
@ASE360
#JADEL
Just dropped in CASE
@CASEfromASE
One of the more unusual cases of AR... be sure to read about this:
Whats your best guess?
A. BAV
B. Aneurysmal SOV
C. Endocarditis
D. Aortic dissection
E. Other
@ASE360
#JADEL
@ASE360
LVOT PWD: what’s the flow just prior to the stroke volume flow?
A. Artifact
B. Lobster claw deformity
C. Arrhythmia
D. Cor fistula
E. Systolic anterior motion MV
F. Subaortic membrane
G. Other (I can go on all day)
Discuss...
Excellent case example to consider when assessing myocardial deformation... thx to Jens-Uwe Voigt (Belgium).
@ASE360
@escardio
This is the same high quality echo from the same patient measured seconds apart on the same system (on EACVI YouTube video):
#JADEL
Just dropped
@CASEfromASE
:
22F presents to ED 5d after normal delivery with CP, HA, HBP and vision changes.
Can you spot the abnormality in this 4-chamber view?
Details:
@ASE360
@JournalASEcho
#JADEL
In Press E-Alert
@CASEfromASE
Have you ever seen endomyocardial fibrosis coexist with apical HCM? I thought not... well, before now anyway!
Read details here & follow thread for more videos:
@ASE360
Mistake made: TAVR for mismatch
TEE- “Severe AVR stenosis”
(look close - see leaflets?)
Pt refused redo AVR
TAVR VIV performed
Post TAVR mean AV 40mmHg
TAVR /AVR removed en bloc
(see distorted, but otherwise normal, leaflets from “mismatch”)
Redo AVR with good results
Just dropped at
@CASEfromASE
Check out this 5-chambered heart by
@AJamilTajik
et al:
Its a wonderful read with outstanding images, but this CMR was my favorite & shows a novel "apical 5-chamber view"!
@ASE360
@JournalASEcho
#JADEL
@CASEfromASE
@ASE360
Q. What’s up with this?
(Hint follow thread for bubble study & answer)…
A. Small hand
B. Clot
C. MCS
D. Dehisced septal closure device
E. Something else
Another amazing CASE from the brilliant authors at
@CASEfromASE
... check it out!
Q. Based only on this image, is this...
A. Flail left cusp
B. Aortic dissection
C. Simple vegetation
D. Fibroelastoma
E. Subaortic membrane
Read all about it:
@ASE360
#JADEL
Just dropped
@CASEfromASE
Have you ever seen this? Y or N
What's missing here? Pericardium or Leaflet
Obvious Question:
How would this make the Bishop's Miter look?
@ASE360
#JADEL
You are never too old to be diagnosed with congenital heart disease for the first time!
Check out this AV septal defect in an adult & compare with the CMR images in the latest
@CASEfromASE
@ASE360
@Ahmad_Elashery
#JADIL
#LNTS
@SCMRorg
@ASE360
If a picture is worth a thousand words, what are the following 10 images worth?
Amazing finding in this unfortunate lady being treated for a hematologic cancer. Follow thread for diagnosis.
2DE subcostal
#echofirst
50M with known systolic click & reported MVP, suddenly develops severe dyspnea! What happened?
#JADEL
@ASE360
@CASEfromASE
A. endocarditis
B. pap m rupture
C. chord rupture
D. progressive chronic MR
E. other
#LNTS
Which of the following is most correct?
A. Normal LV size & function
B. Noncompaction
C. CAD post infarct
D. D-TGA
E. Other
#EchoBoardsPrep
#CMRhelpsECHO
#JADEL
- Transcatheter debulking of TV IE
- Used for pts w/ sig risk from surgery
- Real-time TEE guidance helps facilitate removal of veggies, optimize cannula positioning, & monitor for complications
Read
@CASEfromASE
to see what they 'sucked out':
This just in from
@CASEfromASE
:
Acquired Dynamic Left Ventricular Outflow Tract Obstruction: A Rare Complication of Acute Myocardial Infarction
Really important CASE; great images; important teaching points!
Read more:
@ASE360