Borowski A, Korb H, Voth E, de Vivie E R
Clinic for Thoracic and Cardiovascular Surgery, University of Göttingen, FRG.
Thorac Cardiovasc Surg. 1988 Dec;36(6):338-40. doi: 10.1055/s-2007-1022976.
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.
本报告描述了一例罕见的无症状心肌脓肿病例,该病例与感染性心内膜炎无关,但被诊断为肿瘤并接受了心脏直视手术治疗。一名69岁、无感染性心内膜炎或心肌梗死病史的患者在肱动脉发生栓塞事件后接受了侵入性心脏诊断检查。检查发现一个“心脏内肿瘤”,患者随后接受了心脏直视手术。心脏切开术后,在左心房后壁靠近二尖瓣环处发现了疑似肿瘤,表现为一个边界清晰、质地坚硬且平坦的区域。切开活检后,一个奶酪样的脓液从一个腔隙中流出。组织切片显示为壁内心肌脓肿。由于脓肿的范围、位置和特征,冲洗后使用褥式缝线封闭了腔隙。术后过程顺利。本报告表明,在疑似心脏肿瘤的情况下,尽管心肌脓肿事件罕见,但在任何鉴别诊断中都应考虑到,因为心肌脓肿的诊断并非手术干预的绝对指征。