Invasive aspergillosis: extensive cardiac involvement demonstrated by cardiac magnetic resonance

Transplanted Heart Complicated by Intracardiac Aspergilloma With Pericardial Involvement

A cardiac transplant recipient initially presented with right eye pain and blurry vision. After extensive workup, she was diagnosed with intracardiac aspergilloma with pericardial involvement complicated by endogenous endophthalmitis and acute myocardial infarction, treated in part with mechanical debulking using the Angiovac system (AngioDynamics).

Invasive cardiac aspergillosis as contiguous infiltration from mediastinum: Imaging evaluation using cardiac MRI

Invasive cardiac aspergillosis is a rare, potentially fatal disease which poses a significant diagnostic challenge. Combination of clinical details, imaging features, fungal markers, serology and fungal isolation with demonstration of invasion is usually necessary to establish the diagnosis. High index of suspicion is the key for early diagnosis with potential role of cardiac MRI in its early detection, delineation of extent of involvement and guidance to the appropriate site for tissue sampling, thereby allowing for improved prognosis with early institution of appropriate therapy.

Intracardiac Aspergilloma in a Post-Transplant Patient: A Multimodal Approach to Diagnosis

Cardiac aspergillomas are rare and associated with high mortality. We present a case of right ventricular cardiac aspergilloma in an asymptomatic renal transplant recipient. Intracavitary aspergilloma is an important consideration in evaluation of an intracardiac mass in an immunocompromised patient. (Level of Difficulty: Advanced.).

Intra-cardiac aspergilloma in a normally structured heart: A case report

Fungal endocarditis is a relatively rare condition which mostly complicates those with intra-cardiac devices and those whose immune system is compromised. Here we present a 63-year-old diabetic man with two-weeks history of weakness and fatigue plus low-grade fever. Transesophageal echocardiography showed a mobile mass attached to the left coronary cusp of the aortic valve which protruded into the left ventricular (LV) outflow tract. Cardiac magnetic resonance further confirmed the presence of a large broad base 18 × 20 × 18 mm mass without gadolinium enhancement suggestive for fungal infection. Voriconazole was administered on the same day after which distal embolization of the mass to distal abdominal aorta ensued shortly. Echocardiography documented the disappearance of the mass from LV outflow tract. Vascular surgeon removed the mass from abdominal aorta immediately and pathology revealed the aspergilloma which was later confirmed by culture. After embolization the patient had become unstable and signs of septic shock occurred which ultimately led to his death in 72 h. Presence of Aspergillus infection in apparently normal cardiac chambers without presence of any intra-cardiac device is extremely rare and the presented case study reports such a scenario. Rapid initiation of anti-fungal agents and early surgery are of paramount importance in patient survival. <Learning objective: Cardiac aspergillosis is a rare condition and delayed diagnosis and treatment can be fatal. Cardiac imaging though helps differentiate the intra cardiac mass etiology, must not hinder early surgical removal especially when the location of the mass is critical.>.

Incidental cardiac aspergillomas in an immunocompromised woman

We report a case of 3 autopsy proven incidental cardiac aspergillomas, a rare and yet deadly manifestation caused by Aspergillus. A 48-year-old Caucasian woman affected by a large B-cell lymphoma was referred to our institute for a whole-body fluorine-18 fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography restaging examination, which demonstrated 3 intracardiac masses. The patient was hospitalized, and both a transthoracic echocardiogram and a cardiac magnetic resonance imaging examination were performed. None of the imaging modalities provided a definitive diagnosis. A positive serum galactomannan assay allowed for the initiation of antifungal therapy, but, nevertheless, the patient died a few days later. This case highlights the need to consider cardiac aspergilloma in the differential diagnosis of cardiac masses, especially in immunocompromised patients. Though noninvasive imaging modalities and cardiac magnetic resonance imaging, in particular, help determine the nature of a cardiac lesion, cardiac aspergilloma shows no distinctive radiological features. A high degree of clinical suspicion is therefore key to achieving a timely diagnosis. Histopathological examination with microbiological confirmation remains the diagnostic gold standard.

Cardiac Aspergilloma: A Rare Case of a Cardiac Mass Involving the Native Tricuspid Valve, Right Atrium, and Right Ventricle in an Immunocompromised Patient

Aspergillus can cause devastating opportunistic infections in immunocompromised patients. Rarely does this fungus invade the heart, and when it does, survival is especially poor despite optimal medical and surgical treatment. We report a case of cardiac aspergilloma with involvement of the tricuspid valve and both the right atrium and ventricle found on a transthoracic echocardiogram in an immunocompromised patient after developing atrial fibrillation with rapid ventricular rate. The findings from this case suggest that early clinical suspicion is critical in early diagnosis and thus early treatment.

Endomyocardial and pericardial aspergillosis in critically ill patients

Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affecting mainly immunocompromised hosts; however, during the last two decades its incidence was increasingly observed in critically ill immunocompetent patients. The objective of this study is to describe the clinical characteristics of histologically proven endomyocardial and pericardial invasion, in the context of IA, in critically ill patients. Eight critically ill patients with histopathological confirmation of endomyocardial/pericardial aspergillosis were evaluated. Risk factors, clinical and laboratory characteristics, treatment, histopathological characteristics and mortality were recorded. Signs and symptoms of cardiac dysfunction were not observed in any of the patients. Therapy was administered to six of them shortly after the first positive culture. The observed histopathological lesions included haemorrhagic lesions, small vessels with central thrombosis and surrounding consolidated tissue with necrosis. Voriconazole, caspofungin, lipid amphotericin B and itraconazole were the used antifungals. The mortality rate was high (87.5%). Endomyocardial and pericardial aspergillosis are devastating complications of invasive aspergillosis. Clinical suspicion is low making the diagnosis difficult, therefore histopathological examination of tissues are required. The mortality is high.