Intramyocardial abscess and endoventricular thrombosis: a complex case

Int J Cardiovasc Imaging. 2024 Jul;40(7):1597-1603. doi: 10.1007/s10554-024-03088-w. Epub 2024 Apr 13.

Abstract

Infective endocarditis (IE) is today a public health problem, as the recent ESC Guidelines have also recalled. Abscesses can be complications of IE and their presence means that the infection is not controlled. We describe the complex case of a 57-year-old patient, presented in ED for fever and oleocranical bursitis, increase of cardiac enymes at blood samples. He was admitted to our Cardiology Unit because TTE showed a floating peduncolated formation in the left ventricle. The susequent TEE documented also the presence of a myocardial abscess, confirmed at cardiac MRI. Blood cultures were positive for MSSA and the man received specific antibiotic therapy. Anticoagulation treatment was started with UFH and then switched to Warfarin, surgical approach of the lesion would have been too dangerous according to Cardiac Surgeons. Serious and sudden neurological complications then followed, leading the patient to brain death in ICU.

Keywords: Abscess; Antibiotic therapy; Echocardiogram; Infective endocarditis.

Publication types

  • Case Reports

MeSH terms

  • Abscess* / diagnostic imaging
  • Abscess* / drug therapy
  • Abscess* / microbiology
  • Anti-Bacterial Agents* / therapeutic use
  • Anticoagulants / therapeutic use
  • Echocardiography, Transesophageal*
  • Endocarditis, Bacterial* / complications
  • Endocarditis, Bacterial* / diagnosis
  • Endocarditis, Bacterial* / diagnostic imaging
  • Endocarditis, Bacterial* / drug therapy
  • Endocarditis, Bacterial* / microbiology
  • Fatal Outcome
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Staphylococcal Infections / complications
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / diagnostic imaging
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / microbiology
  • Thrombosis* / diagnostic imaging
  • Thrombosis* / drug therapy
  • Thrombosis* / etiology
  • Thrombosis* / microbiology
  • Thrombosis* / surgery
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Anticoagulants