Multimodal Imaging of a Mitral Paravalvular Abscess
| Autor: | Lowell Chang, Promporn Suksaranjit, Christopher J. McGann, Daniel N. Sommers, Brent D. Wilson |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Echocardiography
Three-Dimensional Heart Valve Diseases Magnetic Resonance Imaging Cine 030204 cardiovascular system & hematology Transesophageal echocardiogram Multimodal Imaging 03 medical and health sciences 0302 clinical medicine Cardiac magnetic resonance imaging Mitral valve medicine Humans cardiovascular diseases 030212 general & internal medicine Abscess Images in Cardiovascular Medicine Mitral regurgitation medicine.diagnostic_test business.industry Magnetic resonance imaging Endocarditis Bacterial Anatomy Middle Aged medicine.disease medicine.anatomical_structure Ventricle cardiovascular system Mitral Valve Female Cardiology and Cardiovascular Medicine business Perfusion Echocardiography Transesophageal |
| Zdroj: | Texas Heart Institute Journal. 43:100-102 |
| ISSN: | 1526-6702 0730-2347 |
| Popis: | A 63-year-old woman who presented with a 2-week history of fever and fatigue was found to have persistent group B β-hemolytic streptococcal bacteremia. A transesophageal echocardiogram (TEE) showed a mobile mass adhering to the mitral valve (MV). Two- and 3-dimensional TEE revealed a large echodense structure in the left atrium, adhering to the intra-atrial septum and posterior MV leaflet, along with a retrocardiac mass (Fig. 1). The patient was referred for cardiac magnetic resonance imaging. Steady-state free-precession images with T1 weighting showed a thickened posterior MV leaflet with vegetation, severe mitral regurgitation, and a myocardial mass involving the basal inferior wall of the left ventricle (LV) (Fig. 2). Dynamic first-pass perfusion images revealed a hypoperfused mass with no enhancement when compared with normal myocardium (Fig. 3A). Double-inversion-recovery (DIR) images with T1 weighting revealed mild heterogeneity of the mass (Fig. 3B). Pre- and post-contrast DIR and late-gadolinium-enhanced images with T1 weighting showed substantial peripheral enhancement with central hypointensity (Fig. 3C and Fig. 3D). The diagnosis was mitral paravalvular abscess (PA). The patient underwent debridement of the large abscess, along with MV replacement and reconstruction of the MV annulus and portions of the left atrial and LV wall with bovine pericardial patch. Fig. 1 A) Two- and B) 3-dimensional transesophageal echocardiograms show vegetation on the posterior mitral valve leaflet (arrows) and reveal a retrocardiac mass (arrowhead). Fig. 2 Steady-state free-precession magnetic resonance images in A) vertical long-axis and B) short-axis views show a mitral paravalvular mass (arrows). Fig. 3 Cardiac magnetic resonance reveals the mitral paravalvular abscess (arrows) by means of A) dynamic perfusion, B) pre- and C) post-contrast T1-weighted double-inversion recovery, and D) delayed enhancement modes. |
| Databáze: | OpenAIRE |
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