RESUMEN
A 40-year-old woman presented with fever of unknown origin (FUO) for 2 months. Without a definitive diagnosis and having received multiple empirical antibiotics from outside without relief, she was referred to our centre. Cardiac auscultation was remarkable for a grade 3/6 continuous murmur in the upper left sternal border. Echocardiogram revealed a patent ductus arteriosus (PDA) and a 5×7 mm mobile vegetation at the pulmonary artery bifurcation. Blood culture grew Streptococcus mutans. Embolisation of the vegetation to the pulmonary circulation occurred after the start of intravenous antibiotics resulting in fever relapse. Antibiotics were continued for 6 weeks and the fever settled. She underwent device closure of PDA after 12 weeks and is currently doing fine. Infective endocarditis/endarteritis is an important differential in a patient of FUO. A thorough clinical examination is important in every case of FUO, gives an important lead into diagnosis and guides appropriate investigations to confirm it.
Asunto(s)
COVID-19 , Conducto Arterioso Permeable , Endarteritis , Fiebre de Origen Desconocido , Adulto , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/diagnóstico por imagen , Endarteritis/diagnóstico , Femenino , Fiebre de Origen Desconocido/etiología , Humanos , Pandemias , SARS-CoV-2RESUMEN
PURPOSE: A linear valve-like structure at the pulmonary artery terminus is identified on CT in some patients with patent ductus arteriosus (PDA) and can potentially be mistaken for endarteritis. The purpose of this study was to evaluate the differences in CT features between adult patients with PDA and a linear structure and those without. MATERIALS AND METHODS: We retrospectively evaluated ECG-gated cardiac CT of 38 patients with PDA dividing them into two groups [patients with linear symmetrical valve-like structure (group1, n = 16), and those without (group 2, n = 22)]. We analyzed CT findings of the PDA including length, minimal and maximal diameter, presence of calcification, and PDA type, comparing the two subgroups. The authors also investigated the prevalence of endarteritis. RESULTS: There was no difference in CT findings between the two groups in the prevalence of calcification and length, and minimal and maximal diameter of PDA. Notably the linear valve-like structure was only identified in type 1 PDA (cone-shaped PDA) (p = 0.04), while there were variable types of PDA in group 2. There was only one case of endarteritis as a complication of PDA in group 1. In contrast to a linear valve-like structure, asymmetrical nodular thickening was noted in the patient with endarteritis on CT overlying the pre-existing linear valve-like structure at the pulmonary end of PDA. CONCLUSION: A linear valve-like structure is frequently identified at the pulmonary end in type 1 PDA. This CT finding should not be mistaken for endarteritis in the absence of other clinical evidence.
Asunto(s)
Conducto Arterioso Permeable/diagnóstico , Endarteritis/diagnóstico , Arteria Pulmonar/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Conducto Arterioso Permeable/patología , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Arteria Pulmonar/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications. CASE PRESENTATION: We report a 47-year-old man with pulmonary endarteritis. This patient presented with hypertension, chest pain and a previous history of pulmonary valve disease during childhood. Also, eight-months prior, he was hospitalized with dyspnea (Functional Class III), cough, phlegm, and night sweats without fever. Echocardiographic diagnosis in the first transtransthoracic echocardiography (TTE) was intense pulmonary valve stenosis (PVS) an, thus, the pulmonary valve vegetation and PVS, established by transesophageal echocardiography (TEE). He was referred for surgery after 1 weeks of intravenous antibiotic therapy for removal of the vegetation. CONCLUSIONS: Finally he was asymptomatic at 3-months of follow-up and was clinically in good condition. Therefore, the detection of infective endocarditis of the lung valve must not lengthy be prolonged.
Asunto(s)
Endarteritis/diagnóstico , Endocarditis Bacteriana/diagnóstico , Embolia Pulmonar/diagnóstico , Sepsis/diagnóstico , Antibacterianos/uso terapéutico , Ecocardiografía Transesofágica , Endarteritis/diagnóstico por imagen , Endarteritis/terapia , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/terapia , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/terapia , Válvula Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Sepsis/terapia , Tomografía Computarizada por Rayos XRESUMEN
Percutaneous endovascular procedures (PEPs) are increasingly common in clinical practice. Percutaneous closure devices (PCD) ensure safe and immediate haemostasis, reducing the length of hospitalisation and improving patient comfort. Infectious complications are rare. We present the case of a 65-year-old man who was admitted to hospital because of fever and weight loss. He had a history of carotid arterial disease, having been submitted to a PEP 3 weeks before. On admission, he presented feverishly. Anaemia and elevated inflammatory parameters were detected on basic chemistry. Blood cultures isolated methicillin-sensitive Staphylococcus aureus and antibiotic therapy was started. He maintained fever and developed signs of right lower limb ischemia. Bacterial endocarditis was ruled out. Positron emission tomography (PET)-scan revealed inflammatory activity involving the right femoral artery (RFA). Bacterial femoral endarteritis was confirmed on surgical exploration, which documented the presence of infected PCD and occlusion of RFA. After surgery, apyrexia and improvement of ischaemic signs were achieved.
Asunto(s)
Endarteritis/diagnóstico , Endarteritis/microbiología , Arteria Femoral/cirugía , Infecciones Estafilocócicas/diagnóstico , Dispositivos de Cierre Vascular/efectos adversos , Anciano , Angioscopía , Cultivo de Sangre , Diagnóstico Diferencial , Endocarditis Bacteriana , Humanos , Masculino , Staphylococcus aureusRESUMEN
Pulmonary endarteritis caused by Dirofilaria immitis and pulmonary hypertension (PH) are closely linked and the determination of PH could be validated to assess the severity and chronicity of the vascular damage, i.e. by the use of the Right Pulmonary Artery Distensibility (RPAD) Index. The aim was to evaluate the RPAD Index in dogs 10 months after the last dose of adulticide. The study included 23 client-owned dogs with heartworm brought for adulticide treatment. Echocardiographic exam was carried out to estimate worm burden, RPAD Index as well as other routine echocardiographic values on day 0 (diagnosis), day 120 (discharge), and 10 months after the last dose of adulticide. No significant differences were observed in the RPAD Index over time, neither when microfilaremic status and parasite burden were evaluated. An RPAD Index <29% was found in 52.2% of the dogs on day 0, day 120, and 10 months after the last dose of adulticide. Regarding other echocardiographic parameters, only significant differences were observed on tricuspid annular plane systolic excursion (TAPSE) values between day 0:day 120 (pâ¯=â¯0.008), and day 0:end of the study (pâ¯=â¯0.037). There was not significant improvement in pulmonary damage 10 months after the elimination of the parasites (pâ¯=â¯0.296), suggesting that, once the endarteritis has developed, the vascular changes are chronic and may not be reversible. The modifications of the TAPSE value suggest an improvement in the systolic function of the right ventricle after the disappearance of the worms, independently of the presence of PH. The endarteritis causes a decrease in the elasticity in the pulmonary vasculature and an increase in the resistance that, chronically, and depending on the severity, will cause the development of PH and later right heart failure. This complication of the disease is one of the most damaging and frequent, so it is necessary to adequately monitor PH in dogs undergoing adulticide treatment. Furthermore, knowing the pulmonary status could provide valuable information to help provide an objective prognosis and help assess the need to add additional treatments, once the worms have been eliminated.
Asunto(s)
Dirofilaria immitis , Dirofilariasis/patología , Enfermedades de los Perros/patología , Endarteritis/veterinaria , Enfermedades Pulmonares/veterinaria , Animales , Antiparasitarios/uso terapéutico , Dirofilariasis/complicaciones , Dirofilariasis/tratamiento farmacológico , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/tratamiento farmacológico , Perros , Endarteritis/complicaciones , Endarteritis/diagnóstico , Endarteritis/patología , Concentración de Iones de Hidrógeno , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/patología , Factores de TiempoRESUMEN
An 11-year-old boy presented with Staphylococcus aureus infective endarteritis and mycotic pseudoaneurysms within the context of a previously undiagnosed aortic coarctation. He had an urgent resection of the pseudoaneurysm and coarctation repair. Nuances to his initial diagnosis and key learning points related to the complication of pseudoaneurysm are discussed.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma Infectado/etiología , Aneurisma de la Aorta Torácica/etiología , Coartación Aórtica/complicaciones , Endarteritis/etiología , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/aislamiento & purificación , Aneurisma Falso/diagnóstico , Aneurisma Falso/microbiología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/microbiología , Coartación Aórtica/diagnóstico , Niño , Diagnóstico Diferencial , Endarteritis/diagnóstico , Endarteritis/microbiología , Humanos , Imagenología Tridimensional , Masculino , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Tomografía Computarizada por Rayos XRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Endarteritis/complicaciones , Endarteritis/diagnóstico , Endarteritis/terapia , Propionibacterium acnes , Propionibacterium acnes/aislamiento & purificación , Propionibacterium acnes/patogenicidad , Infecciones Relacionadas con Prótesis/complicaciones , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Síndrome de Marfan/complicaciones , Fiebre/complicaciones , Síndrome de Marfan/tratamiento farmacológico , Fiebre/etiología , Síndrome de Marfan/diagnóstico , Ecocardiografía , Tomografía Computarizada de Emisión/métodos , Tomografía Computarizada de EmisiónRESUMEN
Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.
Asunto(s)
Antibacterianos/uso terapéutico , Brucella abortus/aislamiento & purificación , Brucelosis/diagnóstico , Endarteritis/microbiología , Mataderos , Anciano , Animales , Enfermedades de la Aorta/cirugía , Bacteriemia/diagnóstico , Prótesis Vascular , Brucelosis/microbiología , Brucelosis/terapia , Doxiciclina/uso terapéutico , Ecuador/etnología , Endarteritis/diagnóstico , Endarteritis/terapia , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/terapia , Gentamicinas/uso terapéutico , Humanos , Masculino , Exposición Profesional , Pronóstico , Rifampin/uso terapéutico , Úlcera/cirugíaAsunto(s)
Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Endarteritis/diagnóstico , Endarteritis/cirugía , Adulto , Antibacterianos/uso terapéutico , Terapia Combinada , Diagnóstico Diferencial , Ecocardiografía/métodos , Endarteritis/tratamiento farmacológico , Endarteritis/microbiología , Humanos , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Endarteritis/complicaciones , Endarteritis/diagnóstico , Propionibacterium acnes/aislamiento & purificación , Dolor Abdominal/etiología , Infarto del Bazo/complicaciones , Infarto del Bazo/diagnóstico , Esplenectomía/métodos , Electrocardiografía , Vancomicina/uso terapéutico , Gentamicinas/uso terapéutico , Endarteritis/tratamiento farmacológico , Endarteritis , /métodos , Escalofríos/complicacionesRESUMEN
Six cases of bacteremia and one of endarteritis were identified between 1986 and 2010 in a general hospital in Chile. Five of these cases occurred during the second half of this timeframe, Campylobacter fetus predominated (5 out of 7) and the majority of the infections presented during warmer months. The mean age was 32.4 years (range 19 to 63) all had comorbidities, and main clinical manifestations included fever with diarrhea. Four patients developed hypotension and two septic shock. The latter, associated to C. fetus bacteremia, died before microbiological diagnosis. Six out of 7 patients received antimicrobial therapy. During 2004 and 2010, the rates of Campylobacter spp. positive stool cultures in the same hospital increased 4 times, suggesting an emerging profile. Bacteremia and endarteritis by Campylobacter spp. can develop in vulnerable patients and manifest as fever with or without diarrhea. Finding curved or spiral shaped gram negative rods in blood cultures leads to suspect this pathogen. Species identification is of utmost importance due to antimicrobial resistance especially in C. jejuni. Prognosis is unfavorable due to host characteristics, and case-fatality rate is high.
Asunto(s)
Bacteriemia/microbiología , Infecciones por Campylobacter/microbiología , Endarteritis/microbiología , Adulto , Anciano , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Campylobacter/aislamiento & purificación , Infecciones por Campylobacter/diagnóstico , Infecciones por Campylobacter/tratamiento farmacológico , Chile , Endarteritis/diagnóstico , Endarteritis/tratamiento farmacológico , Heces/microbiología , Femenino , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
A 35-year-old man was admitted to the hospital with prolonged high-grade fever. Chest computed tomography revealed multiple pulmonary infiltrations in both lungs, suggesting septic emboli. Echocardiography revealed patent ductus arteriosus and mobile large vegetations in the pulmonary artery. Because of uncontrollable infection and the imminent possibility of massive pulmonary embolism, he underwent transpulmonary surgical closure of the ductus and resection of the vegetations under hypothermic circulatory arrest using cardiopulmonary bypass. We report a rare case of open heart surgery in a patient with pulmonary infective endarteritis associated with patent ductus arteriosus.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Conducto Arterioso Permeable/cirugía , Endarteritis/cirugía , Paro Cardíaco Inducido , Arteria Pulmonar/cirugía , Infecciones Estafilocócicas/cirugía , Staphylococcus aureus/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Puente Cardiopulmonar , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/diagnóstico , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Endarteritis/diagnóstico , Endarteritis/microbiología , Humanos , Hipotermia Inducida , Masculino , Pruebas de Sensibilidad Microbiana , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/microbiología , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Six cases of bacteremia and one of endarteritis were identified between 1986 and 2010 in a general hospital in Chile. Five of these cases occurred during the second half of this timeframe, Campylobacterfetus predominated (5 out of 7) and the majority of the infections presented during warmer months. The mean age was 32.4 years (range 19 to 63) all had comorbidities, and main clinical manifestations included fever with diarrhea. Four patients developed hypotension and two septic shock. The latter, associated to C. fetus bacteremia, died before microbiological diagnosis. Six out of 7 patients received antimicrobial therapy. During 2004 and 2010, the rates of Campylobacter spp. positive stool cultures in the same hospital increased 4 times, suggesting an emerging profile. Bacteremia and endarteritis by Campylobacter spp. can develop in vulnerable patients and manifest as fever with or without diarrhea. Finding curved or spiral shaped gram negative rods in blood cultures leads to suspect this pathogen. Species identification is of utmost importance due to antimicrobial resistance especially in C. jejuni. Prognosis is unfavorable due to host characteristics, and case-fatality rate is high.
Se presentan seis casos de bacteriemia y uno de infección vascular por Campylobacter spp, observados en 25 años, con el fin de describir sus características clínicas. Cinco de ellos se registraron en la segunda mitad del período, en concomitancia con el incremento de este agente en el porcentaje de coprocultivos, lo que sugiere un perfil emergente. Las infecciones fueron más frecuentes en los meses cálidos, asociadas principalmente a C. fetus (5 de 7) y a co-morbilidad. La edad promedio de los pacientes fue de 32,4 años (rango 19 a 63 años) y todos tenían comorbilidades. Las manifestaciones clínicas más frecuentes fueron diarrea y fiebre (5 de 7 casos) y dos pacientes cursaron con shock séptico (28,6 por ciento). La evolución fue favorable en cinco pacientes pero los dos que presentaron shock asociado a C. fetus fallecieron (28,6 por ciento). Las bacteriemias o infecciones vasculares por Campylobacter spp., aunque infrecuentes, pueden presentarse en pacientes vulnerables y debutar como cuadros febriles, en presencia o ausencia de diarrea. La identificación de la especie involucrada es de suma importancia debido a la escasa actividad terapéutica de cefalosporinas de tercera generación y quinolonas. El pronóstico de estas bacteriemias es grave debido a las características del hospedero y a su elevada letalidad.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Bacteriemia/microbiología , Infecciones por Campylobacter/microbiología , Endarteritis/microbiología , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Chile , Infecciones por Campylobacter/diagnóstico , Infecciones por Campylobacter/tratamiento farmacológico , Campylobacter/aislamiento & purificación , Endarteritis/diagnóstico , Endarteritis/tratamiento farmacológico , Heces/microbiología , Hospitales Urbanos , Estudios RetrospectivosRESUMEN
The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.
Asunto(s)
Arteriosclerosis Obliterante/cirugía , Endarteritis/cirugía , Enfermedad de Raynaud/cirugía , Simpatectomía , Toracoscopía/métodos , Arteriosclerosis Obliterante/diagnóstico , Arteriosclerosis Obliterante/etiología , Arteriosclerosis Obliterante/fisiopatología , Endarteritis/diagnóstico , Endarteritis/etiología , Endarteritis/fisiopatología , Extremidades/irrigación sanguínea , Ganglionectomía/efectos adversos , Ganglionectomía/normas , Humanos , Enfermedad de Raynaud/diagnóstico , Enfermedad de Raynaud/fisiopatología , Factores de Riesgo , Prevención Secundaria , Simpatectomía/efectos adversos , Simpatectomía/métodos , Simpatectomía/normas , Nervios Torácicos/cirugía , Tiempo , Estimulación Eléctrica Transcutánea del Nervio , Resultado del TratamientoAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Proctitis , Endarteritis/complicaciones , Endarteritis/diagnóstico , Endoscopía , Angiodisplasia , Adenocarcinoma/complicaciones , Colonoscopía , Telangiectasia/complicaciones , Telangiectasia/diagnóstico , Argón/uso terapéutico , Proctitis/complicaciones , Endoscopía/efectos adversos , Adenocarcinoma/diagnóstico , Proctitis/diagnóstico , Proctitis/terapia , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/radioterapiaAsunto(s)
Aneurisma Falso/etiología , Coartación Aórtica/complicaciones , Endarteritis/complicaciones , Mediastinitis/etiología , Infecciones Estafilocócicas/complicaciones , Enfermedad Aguda , Adulto , Aneurisma Falso/diagnóstico , Aneurisma Falso/microbiología , Aneurisma Falso/terapia , Coartación Aórtica/diagnóstico , Coartación Aórtica/terapia , Diagnóstico Diferencial , Endarteritis/diagnóstico , Endarteritis/microbiología , Endarteritis/terapia , Femenino , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Humanos , Imagen por Resonancia Magnética , Mediastinitis/diagnóstico , Mediastinitis/microbiología , Mediastinitis/terapia , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Tomografía Computarizada por Rayos XRESUMEN
Infective endocarditis (IE) is rarely seen in pregnancy and puerperal period, and generally occurs in patients with preexisting heart disease or intravenous drug abuse. In this report, we describe a case of a 27-year-old patient with missed diagnosis of rheumatic heart disease and a moderate size patent ductus arteriosus, in whom multisite culture-negative IE/pulmonary endarteritis developed after uncomplicated vaginal delivery.
Asunto(s)
Conducto Arterioso Permeable/complicaciones , Endarteritis/complicaciones , Endocarditis/complicaciones , Cardiopatía Reumática/complicaciones , Adulto , Medios de Contraste , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/cirugía , Ecocardiografía/métodos , Endarteritis/diagnóstico , Endarteritis/cirugía , Endocarditis/diagnóstico , Endocarditis/cirugía , Femenino , Estudios de Seguimiento , Humanos , Periodo Posparto , Intensificación de Imagen Radiográfica/métodos , Cardiopatía Reumática/diagnóstico , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Conducto Arterioso Permeable/diagnóstico , Endarteritis/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Medios de Contraste , Diagnóstico Diferencial , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/terapia , Ecocardiografía Doppler , Endarteritis/etiología , Endarteritis/terapia , Femenino , Humanos , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/etiología , Infecciones del Sistema Respiratorio/terapia , Tomografía Computarizada por Rayos XRESUMEN
In the modern age of cancer therapy, advances in the multidisciplinary management of cancer have resulted in increased rates of survivorship. Radiation therapy (RT) toxicity must be tempered with the desire to achieve dose escalation to provide the best chance of long-term cure. This article is designed to acquaint emergency medicine physicians with common, expected, and potential acute and late complications of RT.