Transillumination: No one outwits me

A 67-year-old woman with a history of mechanical valve replacement; after the dental procedure, she developed dyspnea, malleolar edema, and fever. The 2D transesophageal echocardiogram (TEE) showed no evidence of valve obstruction, mild paravalvular leak, and no vegetations. In the 3D TEE, the presence of masses suggestive of vegetations on the auricular surface of the prosthesis was suspected which were more precisely defined with transillumination rendering. This technique allowed us to observe with precision the vegetations that were not visualized with traditional methods. This highlights its usefulness in patients with prosthetic valves where infective endocarditis is a serious complication.