Defaults: 1X 2X 3X 4X      
UNMC Advertisement
 Go to the EOTD Archive
Echo-of-the-Day Information
The Echo-of-the-Day is a presentation of 1 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

You can change the size and the format of the image or video loops by using the links below the image or video loop.
= Windows Media Video = MP4 Video
= QuickTime = WebM Video
= Flash = Ogg Video
= JPG Image = GIF Image
Image/Video Sizes  
1X = 200x150 pixels
2X = 400x300 pixels
3X = 600x450 pixels
4X = 800x600 pixels
Loop Text Key  
Preop Preop TEE or TTE
Intraop An Intraop TEE
IntraopPreOp Intraop TEE or TTE before Operation
IntraopPostOp Intraop TEE or TTE after Operation
IntraopEnd Intraop TEE or TTE at End of Anesthesia
Post Op Postop TEE or TTE
  = Legacy/Old Video Formats
Echo of the Day Information Table
IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE
Pel and Wilhelm did not have a feverish fight over this diagnosis
Case#: 289
AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.
A patient presented with WPW and these echo loops:
Case Discussion
The diagnosis is Epstein's Anomaly (EA).

The echocardiographic signs of EA are

  • TV Annulus in normal position
  • Apical Insertion of the Tricuspid Valve
  • Atrialization of the Right ventricle
  • Enlarged Right Atrium
  • Enlarged TV Anterior Leaflet
  • Small TV Septal and Posterior Leaflet
  • RV Dilation

The symptoms occur from the TR, other associated congenital anomalies and conduction abnormalities that may be present. EA is associated with the following congenital anomalies:

  • Bicuspid Aortic Valve (BAV)
  • Atretic AV
  • Pulmonary Atresia
  • Hypoplastic PA
  • Subaortic Stenosis
  • Coarctation
  • MV Prolapse
  • LV Moderator Bands
  • VSD
  • Pulmonary Stenosis (PS)
  • LV Noncompaction

50% of patients with EA will have WPW. Other conduction abnormalities are large P waves, 1st degree AV block, RBBB, inferior Q waves and anterior T wave inversion. Patients will typically present with

  • Cyanosis
  • Palpitations/Arrhythmias
  • Sudden Death
  • Right Sided Heart Failure

The treatment for EA, given the high mortality rate in neonates, is surgical repair or replacement. Most medical management focuses on arrhythmima prevention and management of the right sided heart failure.

Dr. Wilhelm Epstein discovered this condition and it was named after him (Epstein's Anomaly). Dr. Epstein also founded another condition where patients with Hodgkin's disease had cyclic fevers that increase and then decrease over one or two weeks. The cyclic phonomena was also discovered by Dr. P.K. Pel (who published the condition just before Epstein). Therefore, the condition was called Epstein-Pel fever (interesting that it wasn't called Pel-Epstein fever). They apparently argued over the etiology of the condition. Epstein-Pel fever only occurs in 5-10% of Hodgkin's patients. Dr. Richard Asher of the Medical Society of London, in 1959, felt that this condition only exists because it has a name.

CME Section
Please answer the following questions correctly to obtain your CME.
CME Activites require a subscription and CME credits. Please purchase a subscription and CME credits.
Instution Info  
User Info  
CME Info  
User License  
Privacy Policy  
CME Sponsor: University of Nebraska Medical Center - Center for Continuing Education This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.
The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CE Sponsor: American Society of Radiological Technologists (ASRT)This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.
Copyright Statement
© Copyright 2000-2019 JLS Interactive, LLC.
Content from this web site may not be used or reproduced for non-personal or
commercial purposes without express written permission by JLS Interactive, LLC.