Rheumatic heart disease is similar in appearance to which condition?

• A. Atherosclerotic stenosis
• B. Calcific aortic stenosis
• C. Infective endocarditis
• D. Normal valve

Answer: (C)

Rheumatic heart disease alters valve structure in a way that can resemble infective endocarditis on ultrasound. The damaged valve becomes thickened and deformed, with restricted motion and abnormal surfaces that can mimic the irregular, mass-like appearance seen with vegetations. Infective endocarditis classically shows mobile vegetations attached to valve leaflets, whereas rheumatic disease tends to produce fixed thickening and commissural fusion. When evaluating a valve with prior rheumatic involvement, the overall look of abnormal leaflet surface and dysfunction can be mistaken for endocarditis if one focuses only on surface irregularity, so the two can appear similar. Clinically, distinguishing features include the mobility and mass nature of vegetations in endocarditis and the history of rheumatic fever with chronic valve deformity in rheumatic disease.