Tubercular splenic abscess in an immunocompetent patient--a rare entity

Tubercular splenic abscess is an uncommon entity. It has been reported in association with immunodeficiency states. Tubercular splenic abscess in an immunocompetent patient is extremely rare. A 24 year old female who had already received a complete course of anti-tubercular therapy (ATT) for pulmonary tuberculosis was diagnosed as having tubercular splenic abscess. She was successfully managed by performing splenectomy. Operative findings and histopathological examinations confirmed the diagnosis.     

Brain abscess (paradoxical) in congenital heart disease

A congenital cardiac case presenting the combination known as the “Tetralogy of Fallot” and terminating with a paradoxical cerebellar abscess is reported, and a review from the literature of ten additional cases of paradoxical brain abscess is discussed. The sudden onset of cerebral symptoms in congenital cardiac cases, where interauricular or interventricular septal defects are suspected should lead one to consider a diagnosis of paradoxical brain abscess regardless of whether a septic focus can or cannot be demonstrated. On the other hand, the presence of an idiopathic brain abscess should lead one to suspect the possibility of the presence of a congenital cardiac anomaly.     

Amebic liver abscess rupturing into the lesser omentum space

A case of an amebic abscess localized in the lesser omentum is reported. There was no sign of a liver abscess in the imaging examination or the operative findings. However, it is likely that the amebic infection occurred after a liver abscess ruptured into the abdominal cavity. Early diagnosis and therapy are required when an abscess of unknown origin borders the liver, given the possibility of amebic abscess.     

THERAPEUTIC FISTULOSCOPY FOR THE MANAGEMENT OF PROLONGED POSTOPERATIVE INTRA‐ABDOMINAL ABSCESS CAUSED BY SMALL INTESTINAL PINHOLE PERFORATION

Fistuloscopy is an effective treatment for intractable fistula, a sometimes difficult to manage postoperative intra‐abdominal complication. A case of a 69‐year‐old male with an abdominal abscess after he underwent right hemi‐colectomy for cecum cancer with invasions into the ileum and sigmoid colon is reported. A re‐operation for lavage and drainage was performed 2 weeks after surgery. However, no obvious origin for the pus was located. Although physiological saline lavage was repeatedly performed, the effusion of pus persisted in the drain at the midline incision about 7 months after surgery. Then, fistuloscopy with an upper gastrointestinal endoscope was performed through the hole of the tube. A pinhole that produced a bubble just below the midline incision was observed. Then, an endoscopic retrograde cholangiopancreatography (ERCP) tube was inserted to obtain images of the small intestine by fluorography and findings suggested a diagnosis of perforation of the small intestine, which appeared to explain why resolution of the abscess was prolonged. After direct drainage to the small intestine with a 40‐cm‐long 7 Fr percutaneous transhepatic cholangio drainage (PTCD) balloon catheter, pus from the tube notably decreased. After confirming that the abscess cavity had disappeared by abdominal computed tomography scan, the PTCD catheter was extracted about 8 months after primary surgery. Since then, no recurrence of cancer or abscess has been observed. In cases of intractable postoperative intra‐abdominal abscess, fistuloscopy using smaller diameter gastrointestinal endoscopy appears to be a valuable diagnostic tool.     

Pseudoaneurisma iatrogénico da aorta ascendente: uma complicação esquecida

Pseudoaneurysms of the ascending aorta are a rare complication of cardiac surgery. However, the poor prognosis associated with this condition if untreated makes early diagnosis and treatment important.We present the case of a 66‐year‐old woman who had undergone mitral valvuloplasty 12 days previously, who was admitted with a diagnosis of new‐onset atrial fibrillation.The transthoracic echocardiogram showed a clot in the right atrium and anticoagulation was initiated, followed by antibiotic therapy.After further investigation, the patient was diagnosed with a pseudoaneurysm of the ascending aorta and underwent surgical repair, followed by six weeks of antibiotic therapy.She was readmitted six months later for an abscess of the lower sternum and mediastinum. After a conservative approach with antibiotics and local drainage failed, recurrence of a large pseudoaneurysm compressing the superior vena cava was documented. A third operation was performed to debride the infected tissue and to place an aortic allograft. There were no postoperative complications.     

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.     

Isolated liver tuberculosis abscess in a patient without immunodeficiency: A case report

Although hepatic tuberculosis is not a rare disease entity, tubercular liver abscess (TLA) is extremely rare. It is usually associated with foci of infection either in the lung and/or gastrointestinal tract or with an immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even rarer. We report on a 28 year old man who developed an isolated tuberculous liver abscess not associated with lung involvement. Ultrasonography and computed tomography of the abdomen showed the abscess lesions in the liver but the diagnosis of tuberculosis was confirmed by histological examination of the wall of the abscess after surgical drainage. Although tuberculous liver abscess is very rare, it should be included in the differential diagnosis of abscess and unknown hepatic mass lesions.     

Mediastinal abscess as a remote complication of CABG combined with temporary cardiac pacing--a case report

A case of a 74 year old patient with a history of CABG with temporary epicardial cardiac pacing, is described. Five years later the patient developed wound infection. Computerised tomography revealed the presence of mediastinal abscess containing surgical material. The patients underwent surgical removal of the abscess with a distal part of an epicardial pacing lead which was left after CABG and was the most probable cause of infection.     

Multiple hepatic abscesses secondary to chicken bone penetration of the colon: A case report

Hepatic abscesses can result from foreign body perforation of the gastrointestinal tract. Although uncommon, reported cases often involve solitary hepatic abscess with no obvious etiology. We describe the case of a 65-year- old female with multiple hepatic abscesses occurring secondary to chicken bone perforation of the sigmoid colon identified on colonoscopy. With prompt diagnosis, the patient was successfully treated with endoscopic removal of the foreign body and broad spectrum antibiotic treatment.     

Echocardiographic demonstration of aortic root abscess after infective endocarditis.

We describe a patient with infective endocarditis in whom the diagnosis was apparent only on two-dimensional echocardiography. There was no clinical or haematological evidence of active endocarditis and the diagnosis was made by the demonstration of an abscess cavity and vegetation posterior and lateral to the aortic root, deforming the left atrial cavity. The findings were confirmed by cardiac catheterisation and operation.     

Aneurysm of the left sinus of Valsalva with fistula in the right atrium. A case report

A case of an aneurysm of the left sinus of Valsalva ruptured in the right atrium is reported. This anomaly was diagnosed in a 30 year old woman who had a continuous systo-diastolic murmur and no signs of cardiac failure. The diagnosis of aneurysm of the left sinus of Valsalva was been determined using 2-D echocardiography, Cardioangiography, in addition, enabled us to recognize the fistula which connected the left sinus of Valsalva with the right atrium. The rarity of this case is supported by two pieces of data: A) aneurysms of the left sinus of Valsalva are the rarest of the sinus of Valsalva aneurysms; B) generally the sinus of Valsalva aneurysms rupture into the adjacent cardiac cavities, while the anomalous fistolous conduits are quite uncommon. The case reported confirms that from an aneurysm of the sinus of Valsalva an atypical fistolous conduit may arise. This could be detected by cardioangiography. In addition echocardiography, is very important, at least as a preliminary examination, for the diagnosis of the sinus of Valsalva aneurysms.     

Development of Epidural Abscess Following Surgical Drainage of Perianal Abscess: Report of a Case

PURPOSE A case of epidural abscess originating from a perianal abscess is reported.METHODS The history of the patient, erythrocyte sedimentation rate, magnetic resonance imaging, and bacteriological tests were used to reach a diagnosis and the possible mechanism.RESULTS Epidural abscess was suspected because the patient had a fever and intense low back pain following drainage of a perianal abscess. Magnetic resonance imaging was used to correctly diagnose the epidural abscess and bacteriologic studies disclosed the pathophysiologic mechanism.CONCLUSIONS Epidural abscess is an extremely rare complication of perianal abscess. It should always be suspected in a patient with acute onset of back pain, fever, history of recent infection, and an elevated erythrocyte sedimentation rate, because delay in diagnosis can cause neurologic compromise and even death.     

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.     

A case of pericholecystic abscess diagnosed by ultrasonography

Pericholecystic abscess is a serious complication of cholecystitis. Though preoperative diagnosis is easy by gray-scale ultrasonography, there has been no case reported in which the communication between pericholecystic abscess and the gallbladder was demonstrated ultrasonically. We experienced a case in which the communication route between a pericholecystic abscess and the gallbladder was successfully demonstrated by a real-time electric linear scanner. Furthermore, the abscess was successfully treated by percutaneous drainage following ultrasonically guided puncture. This success demonstrates that ultrasonography by a real-time scanner can be effective for diagnosis and treatment of acute cholecystitis and pericholecystic abscess.     

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.     

Diastolic restriction caused by an encysted hemopericardium a year after coronary bypass

The case of a 54 year old patient presenting with congestive cardiac failure one year after single aorto-coronary bypass surgery is reported. Paraclinical investigations showed a pericardial effusion compressing the inferior wall of the heart. Echocardiography was essential for diagnosis. This localised compression was responsible for the haemodynamic changes of adiastole. Pericardial drainage confirmed the diagnosis of an encysted hemopericardium containing about 300 ccs of liquid. Right and left cardiac catheter studies before and after surgery, and 8 months postoperatively, showed progressive normalisation of the intracardiac pressures. A volume expansion stress test excluded possible associated pericardial constriction. Therefore, the finding of diastolic restriction with a residual effusion after cardiac surgery should orientate management towards pericardial drainage before considering pericardectomy.     

Pericardial hematoma mimicking pericardial abscess

A 26-year-old man, with human immunodeficiency virus infection, on hemodialysis, was hospitalized due to infective endocarditis. A mechanical prosthetic mitral valve was implanted. During postoperative period, he maintained signs suggestive of infection. The transthoracic echocardiograms (TTE) revealed a pericardial effusion. One week later was visible a circumscribed collection compatible with a pericardial abscess. He was refused for cardiac surgery; however, inflammatory parameters elevation persisted. The TTE showed a periprosthetic mitral leak, and cardiac surgery was performed. The pericardial drainage revealed a hematoma. This case highlights the difficulty on echocardiographic differential diagnosis between a pericardial hematoma and pericardial abscess in clinical practice.     

Abscess of the mitral annulus mimicking left atrial tumour -- case report

A case of a 50-year-old female with hypertension and diabetes, admitted to the hospital due to echocardiographically detected left atrial tumour, is presented. Differential diagnosis included thrombus, myxoma and infectious tumour. The patient underwent surgery. Histopathological examination revealed the presence of an abscess in the left atrium. This report underlines the difficulties in the diagnosis of cardiac tumours.     

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.