BMJ Case Reports 2017; doi:10.1136/bcr-2016-218849
  • Reminder of important clinical lesson

Mitral valve vegetation diagnosed with oesophageal ultrasound with bronchoscope (EUS-B)

  1. Nikhil K Meena4
  1. 1University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  2. 2Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  3. 3Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  4. 4Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  1. Correspondence to Dr Kevin Kuriakose, kkuriakose6{at}
  • Accepted 17 April 2017
  • Published 15 May 2017


Oesophageal ultrasound with bronchoscope (EUS-B) is designed to evaluate mediastinal structures. We describe a case of a 78-year-old woman who presented with altered mental status for 2 weeks. CT head revealed a subacute infarct in the right middle cerebral artery distribution. She was also found to have a lung mass on chest imaging. EUS-B-guided fine needle aspiration demonstrated the presence of adenocarcinoma in station 7 lymph node and in the mass. Immunohistochemistry confirmed it to be a lung primary as the Thyroid Transcription Factor-1 (TTF-1) was strongly positive. During the procedure, the cardiac valves were evaluated, and a mitral valve vegetation was noted. Formal echocardiography confirmed the presence of the vegetation. During hospital stay, the patient developed fever. Her blood cultures grew oxacillin-resistant Staphylococcus aureus. She was subsequently treated for infective endocarditis. We suggest that the use of EUS-B to routinely scan adjacent structures during a procedure may help obtain additional clinical information that may be critical to patient management.


  • Contributors AJK, preparation of manuscript; YMR and KK, case selection and preparation of manuscript; NKM, supervision and revision of manuscript, performed intervention and obtained video attached to the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained from next of kin.

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

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