Int J Cardiovasc Imaging DOI 10.1007/s10554-015-0634-x
IMAGES IN CV APPLICATIONS
Infected patent foramen ovale (PFO) Thomas C. Butler • John Sedgwick • David Platts • Darryl J. Burstow • David Seaton
Received: 27 February 2015 / Accepted: 2 March 2015 Ó Springer Science+Business Media Dordrecht 2015
A 59 years old man presented with a late anterior STEMI, some hours after severe chest pain. He proceeded to primary angioplasty and stenting his proximal LAD artery. An intra-aortic balloon pump inserted for cardiogenic shock at the time of primary angioplasty. Contrast enhanced transthoracic echocardiography using DefinityTM showed extensive regional wall motion abnormalities and an estimated ejection fraction of 14 %. A PICC line was inserted for intravenous inotropic support. The patient however, became febrile during his hospitalization. Blood cultures were taken and subsequently grew a hospital acquired MSSA secondary to PICC line insertion.
A Trans-esophageal echocardiography was performed that demonstrated extensive thickening of the inter-atrial septum at the level of the fossa ovalis with an associated filamentous strand and globular mass that was mobile in the right atrium (measuring 9 mm by 10 mm), (panels A, B, C, D, E and F). Features were consistent with complex infection of a patent foramen ovale with right atrial extension (video 1, 2, 3 and video 4). Thrombus was felt to be less likely in the context of bacteremia and recent PICC line insertion, with positioning deep in the right atrium adjacent to the PFO. The patient was felt to be too high surgical risk for surgical debridement of the infected mass.
Electronic supplementary material The online version of this article (doi:10.1007/s10554-015-0634-x) contains supplementary material, which is available to authorized users. T. C. Butler (&) J. Sedgwick D. Platts D. J. Burstow D. Seaton The University of Queensland, Brisbane, Australia e-mail: [email protected] T. C. Butler J. Sedgwick D. Platts D. J. Burstow D. Seaton The Prince Charles Hospital, Brisbane, Australia
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Int J Cardiovasc Imaging
A
B
C
D
E
F
Fig. 1 TEE Imaging of Infected PFO
He was treated with 6 weeks of intravenous antibiotics. There was concern that the infection may extend to involve the aortic root or erode into surrounding structures. A repeat TOE performed 2 weeks later demonstrated no change in the mass and no extension of infection. Four months
123
after completion of antibiotic therapy, the patient is well with no clinical concern with regards to infection (Fig. 1). Conflict of interest
None.
IMAGES IN CV APPLICATIONS
Infected patent foramen ovale (PFO) Thomas C. Butler • John Sedgwick • David Platts • Darryl J. Burstow • David Seaton
Received: 27 February 2015 / Accepted: 2 March 2015 Ó Springer Science+Business Media Dordrecht 2015
A 59 years old man presented with a late anterior STEMI, some hours after severe chest pain. He proceeded to primary angioplasty and stenting his proximal LAD artery. An intra-aortic balloon pump inserted for cardiogenic shock at the time of primary angioplasty. Contrast enhanced transthoracic echocardiography using DefinityTM showed extensive regional wall motion abnormalities and an estimated ejection fraction of 14 %. A PICC line was inserted for intravenous inotropic support. The patient however, became febrile during his hospitalization. Blood cultures were taken and subsequently grew a hospital acquired MSSA secondary to PICC line insertion.
A Trans-esophageal echocardiography was performed that demonstrated extensive thickening of the inter-atrial septum at the level of the fossa ovalis with an associated filamentous strand and globular mass that was mobile in the right atrium (measuring 9 mm by 10 mm), (panels A, B, C, D, E and F). Features were consistent with complex infection of a patent foramen ovale with right atrial extension (video 1, 2, 3 and video 4). Thrombus was felt to be less likely in the context of bacteremia and recent PICC line insertion, with positioning deep in the right atrium adjacent to the PFO. The patient was felt to be too high surgical risk for surgical debridement of the infected mass.
Electronic supplementary material The online version of this article (doi:10.1007/s10554-015-0634-x) contains supplementary material, which is available to authorized users. T. C. Butler (&) J. Sedgwick D. Platts D. J. Burstow D. Seaton The University of Queensland, Brisbane, Australia e-mail: [email protected] T. C. Butler J. Sedgwick D. Platts D. J. Burstow D. Seaton The Prince Charles Hospital, Brisbane, Australia
123
Int J Cardiovasc Imaging
A
B
C
D
E
F
Fig. 1 TEE Imaging of Infected PFO
He was treated with 6 weeks of intravenous antibiotics. There was concern that the infection may extend to involve the aortic root or erode into surrounding structures. A repeat TOE performed 2 weeks later demonstrated no change in the mass and no extension of infection. Four months
123
after completion of antibiotic therapy, the patient is well with no clinical concern with regards to infection (Fig. 1). Conflict of interest
None.
