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(Circulation. 1999;99:1271.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Roth's Spots

Eytan Z. Blumenthal, MD; Ehud Zamir, MD

From the Department of Ophthalmology, Hadassah University Hospital, Jerusalem 91120 Israel.

Correspondence to Eytan Z. Blumenthal, MD, Glaucoma Unit, Shiley Eye Center, UCSD, 0946, 9500 Gilman Dr, La Jolla, CA 92093-0946.

Roth's spots (named for Moritz Roth, Swiss physician, 1849–1914) are traditionally considered a manifestation of subacute bacterial endocarditis. However, the differential diagnosis of retinal hemorrhages with a central white spot, also referred to as a hemorrhagic cotton-wool spot, includes such entities as anemia, leukemia, retinal phlebitis, Candida albicans infection, vascular diseases, collagen diseases, bacterial sepsis, viral pneumonia, and kala azar, just to name a few, as shown in the figures.¹

Which is the subacute endocarditis–related "true" Roth spot?

View larger version (131K): [in this window] [in a new window]   Figure 1. Behcet's disease with multiple systemic thrombotic manifestations (notice disk involvement).

View larger version (137K): [in this window] [in a new window]   Figure 2. Idiopathic aplastic anemia (white blood cell count, 200; hemoglobin, 5.9; platelet count, 6000).

View larger version (128K): [in this window] [in a new window]   Figure 3. Acute myeloblastic leukemia.

View larger version (130K): [in this window] [in a new window]   Figure 4. A 40-year-old woman with rheumatic heart disease and Streptococcus viridans endocarditis. Three lesions demonstrate, from left to right, evolution of a Roth spot.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

References

1. Roy FH. Ocular Differential Diagnosis. 5th ed. Philadelphia, Pa: Lea & Febiger; 1993:548–549.
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Blumenthal, E. Z. Articles by Zamir, E. Search for Related Content PubMed PubMed Citation Articles by Blumenthal, E. Z. Articles by Zamir, E. Related Collections Cardiovascular imaging agents/Techniques