contact us

Use the form on the right to contact us.

I will not respond to requests for medical advice.

         

123 Street Avenue, City Town, 99999

(123) 555-6789

email@address.com

 

You can set your address, phone number, email and site description in the settings tab.
Link to read me page with more information.

Puswhisperer Blog

09/21 My Blog. I thought when Medscape and I parted ways that it was time to move on from blogging. Turns out I was wrong, I missed writing. Although I am not sure anyone gives a rat’s ass, I decided to resume the blog. Content is uncertain. Certainly ID cases. Maybe other stuff. I don’t know. We will see.

What the Hell is an Eustachian valve?

Mark Crislip

The patient, an IVDA, presents with TNTC septic pulmonay emboli on CT and MSSA in the blood. They often say TNTC (too numerous to count) and really, if they took the time, they could count them. Not this time. I looked at the CT. No way those could be counted.

Does the patient need an ECHO? You know its tricuspid valve endocarditis; could be pulmonic valve but that is very rare. I remember one in my long and storied carrier. Probably not.

But every once and a while the ECHO shows something you don't expect. As this time. A big clot in the IVC. That is odd. Why would that happen?

Eustachian valve endocarditis shows up in a search.

What the hell is an eustachian valve?

The Eustachian valve (EV) is an embryological remnant of the inferior vena cava that during fetal life helps divert oxygenated blood from the IVC toward the foramen ovale to escape the pulmonary circulation. This remnant usually regresses after birth and is considered a benign finding in the majority of cases

Oh yeah. If I ever learned that, I long ago forgot it.

Can it get infected? Yep.

Eustachian valve (also known as the valve of the inferior vena cava) is another valve in close proximity to the tricuspid valve, which can, in rare cases, be the focus of infection. Eustachian valve endocarditis may be an under-recognised complication of Staphylococcus bacteraemia in IVDU population..

There are maybe 37 cases all told.

The location is right, although no valve was seen on TTE.

The reported cases suggest the disease is under-recognized and

demonstrates the significance of systematically interrogating the Eustachian valve during an echocardiography in all patients suspected of having endocarditis

It doesn't make a difference in the type and duration of therapy, but is a curious manifestation of an endocarditis.

I wonder how many I have missed over the years.

Rationalization

Eustachian valve endocarditis: Case report and literature review https://onlinelibrary.wiley.com/doi/full/10.1002/ajum.12078

Eustachian valve endocarditis: a case report on an under diagnosed entity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425621/

Comment