PMC6925778_01
The right parasternal long axis view optimized for the left ventricular outflow tract, shows severe thickening of the aortic valves compatible with aortic bacterial endocarditis (a). In the right parasternal long axis view the aortic color doppler shows a significantly turbulent flow at the valvular cusps, suggestive of valvular aortic stenosis due to bacterial endocarditis (b). The right parasternal transverse (short axis) heart base view depicts, in the middle of the sector image, dramatic thickening of the aortic valve cusps (9.8 mm). The left atrium is below the aorta and it appears slightly compressed by the inflammatory process. On the upper right portion of the picture there is slight anechoic pleural fluid (c).
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fig1
The 2-dimensional study revealed a large hyperechoic vegetation of the aortic valve leaflets (9 mm, on the right parasternal long axes, 5 chamber view) (Figure 1).
Heart necroscopic findings. Aortic valvular suppurative endocarditis with focal myocarditis. Note the large vegetation on valve leaflets.
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fig2
Aortic valve leaflets and myocardium are depicted. Severe diffuse acute suppurative endocarditis and myocarditis is shown (a, original magnification 10x). Separating, surrounding and replacing cardiomyocytes, there are numerous degenerate karyorrhectic neutrophils, a moderate number of erythrocytes, eosinophilic cellular, and karyorrhectic debris (necrosis) and small, basophilic, rod-shaped, 0.5 x 1 microm bacterial aggregates (b, c, d, original magnification 40x) (hematoxylin and eosin stained, formalin fixed-paraffin embedded tissue sections).
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fig3