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.     

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.     

Endocarditis caused by Haemophilus aegyptius

Endocarditis due to Haemophilus is uncommon. This is the first reported case caused by Haemophilus aegyptius. The course of the disease was complicated by pericarditis, congestive heart failure, and myocardial abscess formation. Surgical removal of the damaged aortic valve was not beneficial. The biologic properties of the organism included urea degradation, absence of indole metabolism, and absence of the enzyme ornithine decarboxylase.     

Bacterial Pancarditis with Myocardial Abscess: Successful Surgical Intervention in a 14-Month-Old Boy

A 14-month-old boy with a structurally normal heart presented with signs of cardiac tamponade caused by purulent pericarditis. During his hospital stay, mitral and tricuspid valve endocarditis developed, and a ventricular septal abscess expanded despite appropriate, prolonged antibiotic therapy for methicillin-resistant Staphylococcus aureus. The day before scheduled surgical correction, the abscess ruptured, creating a septal aneurysm. Surgical intervention resulted in an excellent outcome. Throughout the patient''s 67-day hospitalization, the use of echocardiography was crucial in monitoring and diagnosis.In addition to reporting this case, we discuss our diagnostic and treatment considerations. To our knowledge, this is only the 4th report of S. aureus bacterial pancarditis with myocardial abscess.     

Pneumopericardium masquerading as an acute myocardial infarction

We report a case of a 64-year-old woman with increasing shortness of breath due to massive pericardial effusion. Cardiac magnetic resonance imaging (CMRI) identified typical findings for pericarditis. Pericardectomy was needed due to suspicion of pericardial abscess formation. Histological examination of the resected tissue revealed an undifferentiated primary pericardial synovial sarcoma. The present case illustrates that pericardial tumours could be an important differential diagnosis to pericarditis, even if typical findings of pericarditis were present in CMRI.     

Virulent Streptococcus viridans bacterial endocarditis

A particularly virulent form of bacterial endocarditis due to Streptococcus viridans is described in selected patients. The diagnosis of purulent pericarditis and myocardial abscess is delineated. In addition, emphasis is placed on early surgical intervention in the appropriale management of these potentially lethal complications.     

Amoebic pericarditis

An unusual case of chronic amoebic pericarditis is reported in which the diagnosis of pericarditis was suggested on chest X-ray. The echocardiographic feature of multiple cystic lesions were mainly related to the left ventricle, there was thickening of the visceral pericardium, and some restriction to ventricular filling. The cysts contained anchovy sauce like material, and serological tests for amoebiasis were strongly positive. There was no evidence of an amoebic liver abscess. Clinically the patient improved with anti-amoebic treatment, but died later having refused surgery. The clinical picture may have been modified by earlier chloroquine administration.     

Recurrent delayed pericarditis after pacemaker implantation: a post-pericardiotomy-like syndrome?

INTRODUCTION: Pacemaker implantation is a usual technique in cardiology which may be followed by acute pleural effusion and delayed unusual pericarditis. CASE REPORT: We reported the case of a 67 year-old man hospitalized for faintness. Rhythmical auricular disease was diagnosed and pacemaker was implanted without immediate complication. Though pericarditis with tamponade at the day 21 will require emergency pericardiotomy surgery. A recurrent pericarditis at day 45 was treated with anti-inflammatory drugs without relapse at the end of the treatment. DISCUSSION: Repeated delayed pericarditis after pacemaker surgery may be compared to the Dressler syndrome which occurs after myocardial infarction.     

The MB fraction of creatine phosphokinase. An indicator of myocardial involvement in acute pericarditis.

An elevated level of the MB fraction of creatine phosphokinase (CPK) with normal serum myoglobin and normal CPK values was found in a case of acute idiopathic pericarditis. The elevated serum CPK-MB isozyme is suggested to be an indicator of myocardial involvement accompanying acute pericarditis. The normal CPK and serum myoglobin values and the pattern of rapid decrease of CPK-MB level ruled out the possibility of acute myocardial infarction.     

Constrictive pericarditis after myocardial infarction.

Constrictive pericarditis developed in a 55 year old man two years after transmural myocardial infarction complicated by severe acute pericarditis. Pericardiectomy was successful. Although this very rare late complication of myocardial infarction has been reported as a sequela of frank anticoagulant induced haemopericardium, in this case there was no clinical evidence of such an association.     

Constrictive pericarditis after myocardial infarction

Constrictive pericarditis developed in a 55 year old man two years after transmural myocardial infarction complicated by severe acute pericarditis. Pericardiectomy was successful. Although this very rare late complication of myocardial infarction has been reported as a sequela of frank anticoagulant induced haemopericardium, in this case there was no clinical evidence of such an association.     

Constrictive pericarditis in a 19-month-old child

We report a case of chronic nonspecific constrictive pericarditis with myocardial involvement in a 19-month-old infant. The patient underwent total pericardiectomy and had irreversible hemodynamic instability. Constrictive pericarditis is rare in childhood. It may follow several processes, most frequently an infectious disease. The natural course of the disease consists of progressive myocardial dysfunction with atrioventricular valvular involvement. When diagnosis is established early in the course of the disease and treatment started immediately, the evolution is favorable in most instances.     

Subacute tuberculous pericarditis with fibroelastic constriction diagnosed upon pericardiectomy

A patient with subacute pericarditis showed no evidence suggesting tuberculosis until pericardiectomy was performed because of hemodynamic deterioration. The excised pericardium had a rubbery fibroelastic consistency; histologically, there were granulomatous changes characteristic of tuberculosis. Although tuberculous pericarditis is a difficult diagnosis, this case illustrates the diagnostic and therapeutic importance of early pericardiectomy before myocardial inflammatory infiltration occurs together with end-stage pericardial fibrosis and calcification.     

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.     

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.     

Pulmonary actinomycosis complicated by effusive constrictive pericarditis

Abstract A case of pulmonary actinomycosis presenting with a right calf abscess and complicated by effusive constrictive pericarditis is discussed. Clinical improvement occurred with antibiotic therapy and pericardiectomy. There was no evidence of recurrence after 18 months. (Aust NZ J Med 1991; 21: 879–880.)     

Systolic time intervals in constrictive pericarditis. A study before and after digitalis.

Systolic time intervals were studied in 9 patients with documented constrictive pericarditis before and 15 to 20 minutes after intravenous administration of peruvoside (a quick acting digitalis-like glycoside) to determine underlying myocardial dysfunction. Data were compared with those of similarly studied normal subjects and patients with known myocardial dysfunction. Left ventricular ejection time index (LVETI) decreased in normal subjects (P less than 0.01) and in most patients with constrictive pericarditis, and increased marginally in those with myocardial dysfunction (NS) after peruvoside administration. Pre-ejection period index (PEPI) shortened significantly (P less than 0.01) after peruvoside in normal subjects and in patients with myocardial failure, but not in constrictive pericarditis. Likewise the predicted ejection fraction was insignificantly altered in constrictive pericarditis but significantly so (P less than 0.01) in myocardial failure and normal subjects. The response of one patient with constrictive pericarditis to parenteral peruvoside administration was similar to that seen in patients with myocardial failure. This patient had a delayed recovery after pericardiectomy. PEPI/LVETI ratio and ejection fraction were also abnormal in other patients with constrictive pericarditis when compared to normal subjects. Such abnormalities and the unusual response of some patients to administration of peruvoside may reflect underlying myocardial dysfunction in patients with constrictive pericarditis. However, it is possible that the rigid pericardium also contributes to these abnormalities to a varying extent. Systolic time indices and their response to digitalis appear to be a useful, atraumatic method for detecting underlying myocardial dysfunction in patients with constrictive pericarditis.     

Cardiac allograft vasculopathy

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease affecting both intramyocardial and epicardial coronary arteries and is observed in patients during long-term survival after cardiac transplantation. We report a case of CAV complicated with silent transmural myocardial infarction and massive left ventricular thrombus formation associated with silent pericarditis and with ischemic and non-ischemic scar tissue, as detected by cardiac magnetic resonance imaging (CMRI). The authors suggest CMRI as an additional technique along with echocardiography during follow-up of heart transplant recipients. CMRI may contribute to the early identification of areas of myocardial wall abnormalities suggestive of CAV, thus guiding diagnosis and prompt percutaneous treatment.     

Electrocardiogram evolution of acute anterior ST‐segment elevation myocardial infarction following pericarditis

Electrocardiogram is a powerful tool for differentiating acute ST‐segment elevation myocardial infarction (STEMI) and pericarditis. However, an unusual ECG presentation of the simultaneous occurrence of the two conditions has not been reported previously. In this article, we report a case of ECG evolution of acute anterior STEMI following pericarditis with pericardial effusion (PE) and find that QRS complex widening in ECG lead with maximal ST‐segment elevation is also applicable for identifying STEMI even in patients with prior pericarditis. Undoubtedly, our case can help prevent emergency physicians from making incorrect diagnoses and administering inappropriate treatments.     

Constrictive pericarditis and Whipple's disease]

The authors report the case of a 61 year-old patient treated by tetracycline for very probable Whipple's disease who developed constrictive pericarditis requiring pericardectomy. Although intestinal biopsy was negative, histological examination of the resected pericardium was very suggestive of a cardiac localisation of Whipple's disease, showing a fibrous pericarditis with a mononuclear infiltration including PAS-positive histiocytes. In addition, the same histological changes were found in a small fragment of myocardial biopsy. This case illustrates the prevalence and consequences of cardiac involvement in Whipple's disease.