Myocardial abscess resulting in a pseudoaneurysm: case report

Infectious pseudo-aneurysm of the left ventricle: a case report and a review of the literature

BACKGROUND

In the workup of a pediatric patient with pericarditis we found evidence of a pseudo-aneurysm of the left ventricle, which is a rare complication of purulent pericarditis.

CASE PRESENTATION

We present a case of a six-year-old girl who was diagnosed with pericarditis and a fistula between the pericardial and the intra-luminal space of the left ventricle of the heart. She was successfully treated with antibiotics and cardio-thoracic surgery. We found 23 published cases (21 with follow-up) of infectious pseudo-aneurysm of the heart, of which 19 underwent surgery, 5 had fatal outcome, and 2 who refused surgery survived. The majority of cases were associated with Staphylococcus aureus. The exact mechanisms of this rare complication remain unknown.

CONCLUSIONS

A pseudo-aneurysm of the left ventricle is a rare and not well understood complication of a purulent pericarditis most commonly caused by Staphylococcus aureus infection. Because of risk of rupture, surgical intervention is advised.

Diagnostic evaluation of myocardial abscesses. A new look at an old problem

A myocardial abscess is a life threatening complication of infective endocarditis that necessitates early diagnosis in order to identify the need for emergent surgical intervention and improved prognosis. This review discusses the relevant historical aspects, clinical features suggestive of the diagnosis, associated conditions and various appropriate imaging modalities--in particular, trans-thoracic and trans-esophageal echocardiography, Indium-111 radionucleide scintigraphy, and computerized tomographic scanning. Specific clinical and echocardiographic criteria for identifying a myocardial abscess are discussed and comparative data presented from published studies in the literature.