Apical 4 chamber echocardiogram showing tricuspid valve infective endocarditis

The apical four chamber view (panel A) shows irregular masses, which are bulky vegetations (veg) due to endocarditis, attached to the tricuspid leaflets and prolapsing into an enlarged right atrium (RA) which bulges (via the interatrial septum, arrow) into the left atrium (LA). The enlarged right sided chambers makes the presence of severe tricuspid insufficiency highly likely. The M-mode of a vegetation of the septal leaflet of the tricuspid valve is seen in panel B; the mass has a large excursion because it is highly mobile, large, and prolapses into the right atrium. The phonocardiogram (PCG) shows a diastolic (DM) and systolic murmur (SM) which are variable due to the mobility of the vegetations.