Abscess pocket in the vegetation confirmed on 3-dimensional transesophageal echocardiography.

evidence of embolic events. Because of uncontrolled infection and the possibility of pus spreading out into the cardiac structures, we decided to proceed with operation. After resection of the mass with AML, mitral valve was replaced by mechanical prosthetic valve. There was a septated space in the mass. The space was open to the left ventricular side. Histopathology showed suppurative inflammation of the mass (Figure 2). Infective endocarditis caused by P. aeruginosa in patients without i.v. drug use is extremely rare.2 There have been few data on the complications due to P. aeruginosa infective endocarditis. In the present case, an abscess pocket was formed in the vegetation, and this was clearly identified on 3D-TEE. Echocardiography plays a fundamental role in the diagnosis of infective endocarditis, complication recognition, and therapeutic decision making.3 3D-TEE additionally provided detailed anatomic information,4–6 and therefore has increased usefulness in identifying infective endocarditis lesions and their complications. To our knowledge, the present case of P. aeruginosa infec51-year-old woman with end-stage renal disease was admitted with a 1 month history of general weakness and persistent fever. Chronic diabetic foot ulcer was noted on the right heel with calcaneal exposure. Blood and wound cultures had grown Pseudomonas aeruginosa (P. aeruginosa). Transthoracic echocardiography indicated a hypoechoic and homogenous round mass on the left atrial (LA) side of the anterior mitral leaflet (AML), suggesting vegetation. To evaluate associated complications, transesophageal echocardiography (TEE) was done. The 1.4×1.6-cm mass was attached on the LA side of the A3 portion of the AML. The presence of a central halo was noted in the mass. Given that mitral valve aneurysm is frequently associated with infective endocarditis,1 more detailed anatomic information was needed for a differential diagnosis. Three-dimensional TEE (3D-TEE) confirmed the pocket formation in the mass (Figure 1). The echocardiographic findings suggested abscess pocket formation in the vegetation, rather than mitral valve aneurysm. Inside the pocket, there was no evidence of thrombus formation. Also, there was no A