Year : 2018  |  Volume : 21  |  Issue : 2  |  Page : 218--219

Radio-opaque tricuspid aortic valve seen in X-Ray chest as mercedes-benz sign


Gauranga Majumdar1, Surendra Kumar Agarwal1, Prabhat Tewari2,  
1 Department of Cardio Thoracic and Vascular Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Gauranga Majumdar
Department of Cardio Thoracic and Vascular Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
India

Abstract

We are presenting a very interesting X-ray image of the calcific aortic valve in a septuagenarian male patient who underwent successful aortic valve replacement.



How to cite this article:
Majumdar G, Agarwal SK, Tewari P. Radio-opaque tricuspid aortic valve seen in X-Ray chest as mercedes-benz sign.Ann Card Anaesth 2018;21:218-219


How to cite this URL:
Majumdar G, Agarwal SK, Tewari P. Radio-opaque tricuspid aortic valve seen in X-Ray chest as mercedes-benz sign. Ann Card Anaesth [serial online] 2018 [cited 2019 Sep 18 ];21:218-219
Available from: http://www.annals.in/text.asp?2018/21/2/218/229933


Full Text



A 76-year-old male patient presented with the history of recurrent syncopal attack. He was investigated and found to have severe calcific aortic stenosis with the peak gradient of 180 mmHg and mean gradient of 110 mmHg across aortic valve at rest. His X-ray chest lateral view showed classical calcified tricuspid aortic valve with annular as well as cuspal calcification depicting Mercedes-Benz sign [1],[2] which is usually seen in echocardiography of aortic valve [Figure 1]. In literature, roentographic “Mercedes-Benz sign” is described for triradiate radiolucency seen in gallstones due to the presence of gas (Nitrogen) in gallstone fissures.[3] In this case, a classical triradiate radio-opaque shadow mimicking “Mercedes-Benz sign” is seen in lateral X-ray chest due to extensive calcification of aortic valve leaflets. Roentographic evidence of Mercedes-Benz sign of aortic valve is not reported in English literature.{Figure 1}

The X-ray chest posterioranterior view is most commonly ordered radiological imaging during clinical rounds which may not pick up such extensive calcification [Figure 2]. Echocardiography though being a gold standard, can miss on anatomical completeness of evaluation of such valve due to the phenomenon of echo dropouts because of calcium present all around the valve. Here, a simple X-ray lateral view scores over others by revealing marked calcium present in the aortic valve. This finding is clinically very important as further investigation with computerized tomography becomes mandatory to rule out porcelain aorta, presence of significant coronary, coronary osteal and carotid calcium. These investigations may lead to clinically important findings and may alter the course of comprehensive perioperative management and outcome. Aortic valve replacement with bioprosthesis was done successfully, and the patient recovered well.{Figure 2}

Advanced calcific aortic valve disease is a common ailment in the elderly, and transthoracic echocardiography usually confirms the diagnosis, but we would like to recommend that for long-standing aortic valve disease in advanced age patients lateral X-ray is a must, it should not be ignored.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Murphy DJ, McEvoy SH, Iyengar S, Feuchtner G, Cury RC, Roobottom C, et al. Bicuspid aortic valves: Diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT. Eur J Radiol 2014;83:1396-401.
2Sureka B, Bansal K. Mercedes-benz sign. J Clin Diagn Res 2016;10:TL01.
3Delabrousse E, Bartholomot B, Narboux Y, Barrali E, Chirouze C, Kastler B, et al. Gas-containing gallstones: Value of the “Mercedes-benz” sign at CT examination. J Radiol 2000;81:1639-41.