Beaded necklace-like image observed by real time three-dimensional transesophageal echocardiograhy as evidence of bacterial vegetations in a dialysis catheter

We present images observed in a patient with methicillin-resistant Staphylococcus aureus bacteremia from a hemodyalisis catheter and demonstrate the superiority of real time three-dimensional transesophageal echocardiography (RT3D-TEE) over 2D-TEE at identifying catheter-associated infected vegetations. Other studies have reported RT3D-TEE as an improved modality to identify and characterize intracardiac structures. However, to the best of our knowledge, there are no reports describing the specific characteristics of bacterial vegetations in a dialysis catheter. RT3D-TEE could have a central role in the diagnosis of catheter-related blood stream infections, especially given the increased number of hemodyalisis-dependent patients and increased incidence of infections.