Cardiac tamponade during transesophageal echocardiography in a patient with infective endocarditis

Cardiac Imaging for Diagnosis and Management of Infective Endocarditis

Imaging is central to the care of patients with infective endocarditis. While transthoracic and transesophageal echocardiography are the principle imaging techniques, additional modalities including positron emission tomography and cardiac computed tomography, and to a lesser extent intracardiac echocardiography, play an increasing role. This review discusses the role of cardiac imaging in establishing the diagnosis of endocarditis, in predicting its embolic risk and in making decisions regarding the need for and timing of surgery.

A case of cardiac tamponade due to an isolated abscess in the ascending aorta of a pregnant woman with a history of intravenous substance abuse

We describe the case of a 23-year-old white female, 10-12 weeks pregnant, with a history of intravenous drug use and a recently diagnosed pneumonia, who was found deceased in her bed after a night of sleep. Although postmortem serum toxicology tested positive for alprazolam, tetrahydrocannabinol, and morphine, the ultimate cause of death was determined to be cardiac tamponade secondary to an isolated abscess in the ascending aorta. The patient had several risk factors for aortic rupture and cardiac tamponade including intravenous drug use, pneumonia, and pregnancy. However, an autopsy of the patient showed an isolated abscess of the ascending aorta without evidence of infective endocarditis, coronary artery rupture, aortic aneurysm, or aortic dissection making this an unusual case of cardiac tamponade. The aim of this case report is to encourage providers to obtain a tissue culture of any aortic abscesses so that the organisms involved can be identified. The identification of such organisms may help guide antimicrobial treatment in similar presentations in the future.