Abstract
Diagnosis of myocardial abscess without endocarditis is challenging, and a high index of clinical suspicion is fundamental for diagnosis. It should never be ruled out before TEE. And CT could be a helpful modality in case of emphysematous morphology.
Keywords: emphysematous, Escherichia coli, myocardial abscess
Diagnosis of myocardial abscess without endocarditis is challenging, and a high index of clinical suspicion is fundamental for diagnosis. It should never be ruled out before TEE. And CT could be a helpful modality in case of emphysematous morphology.
1. CASE PRESENTATION
A myocardial abscess is a rare and fatal disease, which is known to be challenging to diagnose, especially in case of isolated one without endocarditis. We present a case of emphysematous myocardial abscess detected by computed tomography, and echocardiography, and confirmed by surgery.
An 81‐year‐old woman presented with shortness of breath and fever. Her blood pressure and heart rate were normal; however, she had elevated body temperature (38.9℃). Physical examination, laboratory study, and chest x‐ray indicated sepsis and heart failure. Transthoracic echocardiography showed no abnormality, but computed tomography (CT) demonstrated abnormal air bubbles with low attenuated lesions surrounding the mitral annulus (Figure 1). Transesophageal echocardiography (TEE) revealed a round, echo‐free lesion in the lateral myocardial wall, and a moderate amount of pericardial effusion (Video S1, S2). During the surgery, an abscess pocket was exposed on the posterolateral wall of the left ventricle (Video S3). There was no evidence of endocarditis. The abscess was incised and drained. Escherichia coli was isolated from the tissues and pus of the abscess, and it was the same pathogen isolated from blood culture samples.
FIGURE 1.
Contrast‐enhanced chest computed tomography image revealing abnormal air bubbles with low attenuated lesion (arrows) surrounding the calcified mitral valve annulus (arrowhead)
A myocardial abscess has been generally diagnosed during autopsies or surgeries due to diagnostic difficulty and clinical lethality.1 Prompt diagnosis facilitates timely surgical intervention, and it is crucial for prognosis.2 If myocardial abscess exhibits emphysematous morphology, CT may play an important role in diagnosis, and if there is any possibility of myocardial abscess, it should never be ruled out before TEE.
Disclosures
None.
CONFLICTS OF INTEREST
None declared.
AUTHOR CONTRIBUTIONS
JP: collected the information, edited figure and videos, and drafted the manuscript, SHS: designed the project and supervised the writing the manuscript, YJS: performed transesophageal echocardiography and described findings, SK, DKK, KHK, and DIK: discussed the results and advised about the case, BSP: offered patient's clinical information. All authors read and approved the final manuscript.
ETHICAL APPROVAL
Not required.
Supporting information
Video S1
Video S2
Video S3
ACKNOWLEDGMENT
No relevant acknowledgments. Published with written consent of the patient.
Park J, Seol S‐H, Song Y‐J, et al. Emphysematous myocardial abscess without infective endocarditis. Clin Case Rep. 2021;9:e04658. 10.1002/ccr3.4658
Funding information
None
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
REFERENCES
- 1.Abdul‐Waheed M, Yousuf MA, Schneeberger EW, et al. A rare case of Klebsiella pneumoniae myocardial abscess. J Thoracic Cardiovasc Surg. 2010;139(3):e34‐e35. 10.1016/j.jtcvs.2008.07.056 [DOI] [PubMed] [Google Scholar]
- 2.Chakrabarti J. Diagnostic evaluation of myocardial abscesses. A new look at an old problem. Int J Cardiol. 1995;52(3):189‐196. 10.1016/0167-5273(95)02484-0 [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Video S1
Video S2
Video S3
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.