Libman-Sacks Endocarditis

Libman-Sacks endocarditis (LSE) is a nonbacterial endocarditis associated with lupus, malignancy, and antiphospholipid antibody syndrome characterized by endothelial injury and immune complex deposition typically on left-heart valves (mitral > aortic) causing inflammation and scarring. Unfortunately,...

Lung Point For Pneumothorax Using Ultrasound

With a pneumothorax (PTX), air separates the visceral and parietal pleura layers located on the lung's outside surface and inner chest wall, respectively. The absence of pleural sliding on ultrasonography can suggest PTX, but...

D-Sign: Right Ventricular Strain On Chest CT And Echocardiography

Typically at end-systole, the interventricular septum (IVS) bows rightward as the left ventricle’s pressure (LV) exceeds that of the right ventricle (RV). However, when the RV is strained (e.g., massive pulmonary embolism), the pressure...

My Transesophageal Echocardiography (TEE) Sequence Of Views

As a cardiothoracic anesthesiologist and intensivist, transesophageal echocardiography (TEE) is a powerful cardiac imaging modality I perform in the OR during cardiac surgery and in the cardiovascular ICU when point-of-care ultrasound is not feasible...


Tricuspid annular plane systolic excursion (TAPSE) is a quantitative echocardiography technique to assess right ventricular (RV) systolic function. As an intensivist, I obtain an apical four-chamber view using transthoracic echocardiography, activate motion ("M") mode...

Myocardial Performance (Tei) Index With Doppler Tissue Imaging (DTI)

As part of a comprehensive left ventricular (LV) diastolic assessment, doppler tissue imaging (DTI) of the medial and lateral aspects of the mitral valve (MV) annulus should be performed. In the image below, I...

Mitral Valve Leaflet Perforation

Mitral valve endocarditis can affect any part(s) of the mitral valve apparatus - annulus, leaflets, and even chordae tendinae - resulting in acquired mitral valve regurgitation (MR) through leaflet perforation, rupture of chordae, and...

Ebstein Anomaly

Ebstein anomaly is a rare (~0.005% of the general population) congenital heart condition characterized by the apical displacement of the septal tricuspid valve (TV) leaflet, a "sail-like," long anterior TV leaflet, atrialization of the...

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