UOTW #75 Answer

Answer: Redundant Chordae

  • Chordae tendinae are the fibrous cords that connect the papillary muscles to the tricuspid and mitral valve.
  • Given history and echo findings, there was concern for infective endocarditis (IE) this is an important component of the differential diagnosis, however there are some clues that can help differentiate the two.

Common False Positives for IE1

  • Lambl’s excrescences – filiform fronds that occur at sites of valvular closure
  • Redundant chordae (our patient’s diagnosis)
  • Chordal insertion into normal mitral valve
  • Sutures from implanted prosthetics
Infective EndocarditisFalse positive IE
Echo TextureGray, similar appearance to myocardiumWhite, similar appearance to pericardium
LocationUpstream side of valve, in path of jet, prolapse into upstream chamberDownstream surface of valve
ShapeAmorphous, lobulatedHair or string-like with narrow attachment,
MotionChaotic, orbiting, independent of valve motionMoves in concert with valve, No turbulent flow or regurgitation
  • In general, TTE has a sensitivity of 50% for detecting IE.  If clinical suspicion remains high, TEE has sensitivity in the range of 90 – 100%.2, 3
  • Remember to consider IE in patients with a history of injection drug use, prosthetic valves, or fever coupled with vascular phenomena (embolic pathology).
  • Our patient was ultimately diagnosed with pneumonia and admitted for IV antibiotics.
  1. Kim MJ, Jung HO. Anatomic variants mimicking pathology on echocardiography: differential diagnosis. Journal of cardiovascular ultrasound. 21(3):103-12. 2013. [pubmed]
  2. Evangelista A. Echocardiography in infective endocarditis. Heart. 90(6):614-617. 2004. [article]
  3. Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB. Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. Journal of the American College of Cardiology. 18(2):391-7. 1991. [pubmed]
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