Asymptomatic myocardial abscess

This report describes a rare case of an asymptomatic myocardial abscess which was not associated with infective endocarditis but was diagnosed to be a tumor and treated by open-heart surgery. A 69-year-old patient without a history of endocarditis or myocardial infarction was submitted to invasive cardiac diagnostics after an embolic event in the brachial artery. Investigation revealed an "intracardiac tumor" and the patient subsequently underwent open-heart surgery. After cardiotomy the suggested tumor was found in the posterior wall of the left atrium adjacent to the mitral ring, appearing as a circumscribed, indurated, and plane area. After incision for biopsy, a cheesy pus emptied from a cavity. The tissue sections showed an intramural myocardial abscess. Because of the extent, location and the character of the abscess, the cavity was closed after rinsing using mattress sutures. The postoperative course was uncomplicated. This report demonstrates that in suspected cardiac tumors a myocardial abscess should be considered in any differential diagnosis despite the rarity of the event, since the diagnosis of the myocardial abscess is not an absolute indication for surgical intervention.     

A serial echocardiographic study of myocardial abscess in a patient surviving staphylococcal septicemia

2D echocardiography was performed on a 4-year-old child suffering from right thigh abscess due to MRSA infection following diagnosis of pericardial effusion by USG abdomen. It revealed myocardial abscess and pericardial effusion. This child underwent series of 2D echocardiographic studies which showed image appearance of myocardial abscess with its time course of healing.     

Recurrent myocardial abscess during Streptococcus B endocarditis

The authors report a case of serious streptococcus B endocarditis with a myocardial abscess that recurred after surgery. Streptococcus B endocarditis is a rare disease which is characterized by a pronounced tropism of the organism for cardiac tissues, with severe cardiac valve mutilation and abscess formation in 40% of the cases. A myocardial abscess makes the prognosis worse and must be treated surgically during the acute phase of endocarditis. Modern imaging methods, notably trans-oesophageal two-dimensional echocardiography and computerized tomography should now be used to detect such abscesses.     

Septal myocardial abscess and infectious pericarditis in a case of bacterial endocarditis

A case of acute aortic valve endocarditis is reported, in which the complications of pericarditis and myocardial abscess were diagnosed clinically. Two dimensional and M-mode echocardiography showed large echo-free spaces and a marked thickening of the interventricular septum which had not been detected previously, suggesting pericardial effusion and myocardial abscess. This is the first case in Japan to our knowledge, in which the pericarditis and myocardial abscess were detected preoperatively and successfully treated surgically.     

Sudden death in Staphylococcus aureus-associated infective endocarditis due to perforation of a free-wall myocardial abscess

Free-wall myocardial abscess perforation with hemopericardium and sudden death is an extremely infrequent complication of infective endocarditis (IE). We describe a case of Staphylococcus aureus-associated native aortic and tricuspid valve endocarditis complicated by a septic myocardial infarction and abscess formation of embolic origin, with fatal rupture into the pericardium. To our knowledge, only 2 cases of myocardial abscess rupture have previously been reported in relation to IE.     

Disseminated mucormycosis with myocardial involvement in a renal transplant recipient

We report the case of a renal transplant recipient with pulmonary and splenic mucormycosis whose demise was accelerated by a myocardial abscess. Once pulmonary and splenic mucormycosis was diagnosed, liposomal amphotericin B was started and immunosuppressant treatments were discontinued. The pulmonary cavities regressed during treatment, but new myocardial and peri‐allograft abscesses developed. The myocardial abscess diffusely infiltrated the left ventricular wall and was associated with akinesia, which led to sudden cardiac arrest. This case demonstrates a rare manifestation of mucormycosis and highlights the fatality and invasiveness of this infection.     

Diagnosis and successful management of septal myocardial abscess: a complication of bacterial endocarditis

A case of acute enterococcal aortic valve endocarditis is presented in which the complication of a septal myocardial abscess was diagnosed clinically and successfully treated surgically. This represents the first instant, to our knowledge, in which the preoperative diagnosis of a myocardial abscess served as the indication for emergency cardiac surgical intervention in active endocarditis with successful outcome. The diagnostic parameters permitting clinical recognition of a myocardial abscess include the development of advancing degrees of atrioventricular and bundle branch block, and the finding of pericarditis or pericardial effusion in aortic valvular infections. Two additional findings were noted in the present case: echocardiographic evidence of septal thickening, and loss of septal Q waves on the electrocardiogram. Since myocardial abscesses do not respond to medical therapy, continuous electrocardiographic monitoring and frequent echocardiographic determinations are recommended in cases of active aortic valve endocarditis to permit early diagnosis and surgical management of this complication.     

Myocardial abscess after silent myocardial infarction

A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present. A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable. No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment. After two years the patient is doing well. Only one case of survival has been reported before, also after surgical intervention. This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture.     

Metastatic myocardial abscess due to group F streptococci

Remote myocardial infarction in a 60-year-old, blind diabetic man, was complicated by suppuration within the old fibrotic area by a group F streptococcus. Osteomyelitis of the fifth (right) metatarsal bone served as the primary focus. A review of the literature uncovered no findings which could help to predict the onset of abscess formation within a myocardial infarction. Although this complication occurs rarely, the entity should be kept in mind in patients with infarcts and a remote source of infection.     

Infective endocarditis presenting as ST-elevation myocardial infarction: an angiographic diagnosis

While systemic embolic events occur with relative frequency in infective endocarditis (IE), coronary embolization remains an uncommon cause of ST elevation myocardial infarction. Herein we report a case of ventricular fibrillation and anterior ST elevation myocardial infarction occurring in a patient initially presenting with septic shock. Angiography proved diagnostic for IE of a native bicuspid aortic valve complicated by root abscess and left anterior descending artery occlusion. Histologic examination of the embolectomy specimen from the left anterior descending artery confirmed the presence of thrombus and bacteria. The present case highlights difficulties in identifying and managing patients with coronary embolism of vegetations from IE.     

Acute myocardial infarction and pyocholecystitis. Report of a case

The clinical data of a 43 year old male with acute myocardial infarction and acute abdominal syndrome on the 4th day after the onset of infarction is reported. During abdominal surgery, a gall bladder abscess was found and a cholecystectomy was performed, without abdominal or cardiac complications. This report emphasizes the rare association of these entities and that even in evolving myocardial infarction surgery can be performed with reasonable risk. The collaboration of cardiologist, surgeon and anesthesiologist is suggested.     

Bacteroides fragilis isolated post mortem from an abscess in a myocardial infarct

An unusual case of an abscess complicating a myocardial infarct is described. Similar cases reported so far are reviewed, with special attention to modes of presentation, possible sources of infection and complications.     

Infective endocarditis with myocardial abscesses complicating percutaneous transluminal coronary angioplasty

A 73-year-old man who had undergone percutaneous transluminal coronary angioplasty developed infectious endocarditis caused by Staphylococcus aureus. Echocardiography revealed vegetations of the aortic valve and severe aortic regurgitation. Endotracheal intubation was required for progressive heart failure. Serum creatinine kinase was elevated (411 IU/l: normal 30 to 140 IU/l). Electrocardiography showed no ischemic changes. Aortic replacement was performed to treat progressive heart failure, but the patient could not be weaned off cardiopulmonary bypass and subsequently died. A post-mortem examination revealed multiple myocardial microabscesses and myocardial infarction due to embolic vegetation. The possibility of multiple abscess formation when severe ventricle dysfunction occurs in infectious endocarditis is emphasized.     

Ventricular arrhythmias disclosing myocardial abscess in infectious mitro-aortic endocarditis

The authors report the case of a myocardial abscess in an infectious endocarditis with a double localization, mitral and aortic. The way it is revealed, by severe and recurring ventricular arrhythmias, differs from the conduction disorders usually described. The diagnosis is suspected by non-invasive examinations, echocardiography and nuclear magnetic resonance. It is backed up by angiographic exploration. The intervention confirms the data obtained by cardiac imaging, and enables the ablation of the abscess which is cleaned out, and the cure of the valvular lesions. Taking into account the gravity of this complication, a close clinical, electrocardiographic and echocardiographic surveillance of all infectious endocarditis is necessary.     

A Rare Case of Aspergillus Pericarditis with Associated Myocardial Abscess and Echocardiographic Response to Therapy

Myocardial abscess is an extremely rare entity and is often deadly in nature. We present a case of a patient with recent orthotopic liver transplant, on immunosuppression, who presented with cardiac tamponade due to Aspergillus fumigatus pericarditis and associated myocardial abscess. The diagnosis was made based on computed tomography imaging, culture of pericardial fluid for Aspergillus, and transthoracic echocardiography. The patient received antifungal therapy with clinical improvement and documented reduction in abscess size based on repeat echocardiogram. Aspergillus myocardial abscess is an extremely rare diagnosis but should be considered in an immunosuppressed patient presenting with pericardial effusion or ventricular mass.     

Unusual cause of myocardial infarction and congestive heart failure in a patient with prosthetic valve endocarditis

In a patient with staphylococcus lugdunensis prosthetic aortic valve endocarditis and coronary septic embolism accompanied by antero‐lateral myocardial infarction, embolic material was successfully aspirated from the bifurcation of the left anterior descending coronary artery and the first diagonal branch. A good angiographic result was documented six months thereafter when the patient presented with a second complication, pulsatile compression of the left main coronary artery by an abscess cavity originating between the aortic and mitral annulus, leading to congestive heart failure. The patient underwent successful surgical replacement of the aortic valve prosthesis with concomitant patch reconstruction of the annulus as well as tricuspid annuloplasty. © 2013 Wiley Periodicals, Inc.     

Clinical features of early myocardial rupture of acute myocardial infarction

We assessed the clinical features of patients with myocardial rupture within 48 to 72 hours, defined as early myocardial rupture, after percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI). Six patients (4 men, 66 ± 13 years) with early myocardial rupture were identified from 1252 consecutive patients undergoing PCI for STEMI. We evaluated the degree of microvascular reperfusion using thrombolysis in myocardial infarction (TIMI) myocardial perfusion (TMP) grade and a resolution of sum of ST-segment elevation in a 12-lead electrocardiogram (ECG). Time from PCI to myocardial rupture was 11 ± 7 hours. All patients showed TMP grade 0 or 1 and an increase in sum of ST-segment elevation after PCI (1.9 ± 0.5 vs 2.5 ± 0.7 mV; P = .032), suggesting severely failed reperfusion at the level of microcirculation as the common feature to develop early myocardial rupture after PCI for STEMI.     

Fatal acute bacterial myocarditis after dentoalveolar abscess

A 19 year old woman presented with chest pain after a dental extraction for a dentoalveolar abscess. Electrocardiographic and serum isoenzyme changes were consistent with acute anterior myocardial infarction. At autopsy bacteria were demonstrated within the myocardium in the absence of a myocardial abscess or endocarditis. This case illustrates the occurrence of isolated acute bacterial myocarditis after a dental extraction.     

Myocardial abscess due to Klebsiella pneumoniae complicating acute infarction

A case is described in which Klebsiella pneumoniae urosepsis associated with acute myocardial infarction resulted in myocardial abscess and papillary muscle rupture. The diagnosis was made during surgery for mitral valve replacement. The patient improved after therapy with cefotaxime; however, cardiac rupture occurred on the sixth postoperative day. The pathogenesis of myocardial abscess and the use of non-invasive techniques for diagnosis are discussed.     

Diagnosis of Myocardial Abscess After Acute Myocardial Infarction by Transesophageal Echocardiography: Case Report and Short Review of Published Data

A 56-year-old man received thrombolysis for an anterior myocardial infarction after chest pain for 18 hours. Ten days later he was readmitted with fever and hemodynamic deterioration. Transesophageal echocardiography demonstrated a thin-walled cavity at the apex of the left ventricle. At operation he was found to have a myocardial abscess, and after excision and antibiotics his subsequent clinical course was uneventful. We review the echocardiographic diagnosis and clinical features of myocardial abscess complicating acute infarction. Presumed etiologic factors in our patient included late thrombolysis, mural thrombus, and poor dental hygiene leading to septicaemia.