Mobile valvular structures
| View | Zoomed parasternal and apical views of the valve, multiple planes; grayscale map with enough shades to show low-amplitude structures; TEE when shadowed. |
|---|---|
| Timing | Through the cycle: a true structure has independent motion and an attachment point. |
| Caliper / trace | Describe size, attachment, leaflet or scallop affected, mobility and associated motion (restricted, prolapse, flail); report normal variants (Lambl's excrescence) as such and masses with a suspected etiology. |
Correct example
A linear mobile echo density with independent motion, well-demarcated borders and an attachment that respects anatomic boundaries is a real structure; an artifact has identical or mirrored motion to its source, crosses walls and lacks attachments. Lambl's excrescences are reported as normal variants.
Common error
Reporting a side-lobe or beam-width ghost as a vegetation or thrombus, missing a vegetation hidden in the shadow of a calcified or prosthetic valve, or using too few grayscale shades so a thin mobile structure disappears.
Effect on interpretation
This is a visual differential (normal variant, degenerative strand, vegetation, thrombus, flail chord), not a definitive diagnosis; the report states the suspected etiology and the limitation (shadowing, image quality) rather than a certainty the image cannot support.
Why
Oscillating structures such as leaflets, Lambl's excrescences or a ruptured papillary muscle also generate the tiger-stripes Doppler artifact; recognizing it prevents the bands being read as flow.