The role of real time three-dimensional transesophageal echocardiography in assessing Libman-Sacks endocarditis.

A 33-year-old woman was referred to our echocardiography laboratory because of loud murmur at the apex. Transthoracic and transesophageal echocardiography (TTE and TEE) showed a mass involving the anterior leaflet of the mitral valve. Real time three-dimensional TEE (RT3D TEE) images clearly showed the nodular, irregular and large size of the mass. Based on her laboratory findings and the echocardiographic appearance of the mass, Libman-Sacks endocarditis was prediagnosed. In intraoperative inspection, a large nodular tumor was shown on the atrial side of the anterior mitral valve leaflet. In this case, RT3D TEE is better than all echocardiographic imaging modalities in evaulating vegetation of Libman-Sacks endocarditis.