Pickelhaube Sign on Echocardiogram

Pickelhaube sign may be seen in mitral valve prolapse (MVP): High velocity (≥ 16 cm/s) systolic signal with tissue Doppler imaging resembling the Pickelhaube (Spiked helmet worn in the 19th and 20th centuries by Prussian and German military)

Mechanism: the tugging of the posteromedial papillary muscle in mid-systole by the myxomatous prolapsing leaflets causes the adjacent posterobasal LV wall to be pulled sharply toward the apex

Significance: indicates malignant phenotype of myxomatous mitral valve disease (MMVD) and bileaflet MVP



Abhilash Koratala MD @NephroP 



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