Alamzaib Sardar Muhammad, Rabbani Noor Ul Ann, Sayyed Zoya, Mansoor Kanaan, Lester Melissa D
Interventional Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2023 Apr 26;15(4):e38138. doi: 10.7759/cureus.38138. eCollection 2023 Apr.
The occurrence of perivalvular abscess, a purulent infection that affects the myocardium and endocardium of natural or artificial valve tissues, can result from either the spread of bacteria from a distant source via bacteremia, or from the expansion of an existing infectious cardiac focus, such as infective endocarditis (IE). The aortic abscess should be suspected in patients with infective endocarditis who fail to improve despite being on appropriate antibiotics. Sometimes aortic abscesses can present as PR interval lengthening or heart block due to the extension of infection. We present an atypical presentation of aortic root abscess with chest pain and ischemic EKG changes. A 45-year-old intravenous drug user presented with chest pain episodes with EKG showing ST depression in V2-V6 and ST elevation in avR. The coronary angiographic study showed no significant coronary artery disease, but the patient complained of chest pain. Transthoracic echo in the catheterization lab showed severe aortic regurgitation. The patient became hemodynamically unstable, worsened his respiratory status, and had to be intubated. He had a bedside transesophageal echo that revealed an aortic root abscess. The patient's condition continued deteriorating, and he passed away the same day. This case focuses on the timely diagnosis of aortic root abscess, and Transesophageal echocardiography (TEE) is the gold standard for diagnosing aortic root abscesses. This case also focuses on keeping perivalvular abscess among our differentials in a patient presenting with chest pain and abnormal EKG, especially in a high-risk population.
瓣周脓肿是一种影响天然或人工瓣膜组织心肌和内膜的化脓性感染，其发生可能源于远处细菌通过菌血症传播，也可能源于现有感染性心脏病灶（如感染性心内膜炎）的扩展。对于接受适当抗生素治疗后仍无改善的感染性心内膜炎患者，应怀疑存在主动脉脓肿。有时，由于感染蔓延，主动脉脓肿可表现为PR间期延长或心脏传导阻滞。我们报告一例主动脉根部脓肿的非典型表现，伴有胸痛和心电图缺血性改变。一名45岁的静脉吸毒者出现胸痛发作，心电图显示V2-V6导联ST段压低，avR导联ST段抬高。冠状动脉造影研究显示无明显冠状动脉疾病，但患者仍诉说胸痛。导管室的经胸超声心动图显示严重主动脉瓣反流。患者血流动力学不稳定，呼吸状况恶化，不得不插管。床边经食管超声心动图显示主动脉根部脓肿。患者病情持续恶化，于当日死亡。本病例着重于主动脉根部脓肿的及时诊断，经食管超声心动图（TEE）是诊断主动脉根部脓肿的金标准。本病例还着重于在出现胸痛和心电图异常的患者（尤其是高危人群）中，将瓣周脓肿纳入鉴别诊断范围。
