Endocarditis infecciosa y embolias del eje hepatoesplenorrenal

Méndez, María Luaces; Vilacosta, Isidre; Sarriá, Cristina; Fernández, Cristina; Román, José Alberto San; Sanmartín, Juan V.; López, Javier; Rodríguez, Enrique

doi:10.1016/s0300-8932(04)77261-9

Cited by 9 publications

(10 citation statements)

References 26 publications

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“…However, in clinical practice, US and CT are the most frequently used, especially CT, which is considered superior to US for screening due to its ability to detect changes even in patients with normal ultrasound. [ 15 , 18 ] Almost all CT explorations in this study were performed after the administration of an intravenous contrast agent when infarcts and abscesses were better seen and in the first 2 weeks after hospital admission when the risk of embolic events was higher. [ 7 , 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 15 , 16 ] Ultrasound (US), computed tomography (CT), and more recently magnetic resonance imaging (MRI) are the most commonly used techniques when abdominal involvement is suspected in patients with LS-IE. [ 16 , 17 ] However, despite the relative frequency of these complications, few studies [ 5 , 18 ] have reported if patients with emboli seen on abdominal images have different clinical and etiological characteristics than those without them. Although it could be hypothesized that the involvement of these abdominal organs could cause a poorer prognosis, the influence of the awareness of the presence of these lesions in the treatment and prognosis of LS-IE is unknown.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis

et al. 2018

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Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT.From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed.A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL lesions: 46 splenic, 15 renal, 1 liver infarct, and 2 liver abscesses. Patients with SRL lesions were mainly men (P = .01), had liver disease (P = .001) with natural valve (P = .050) and mitro-aortic valve involvement (P = .042), splenomegaly (P = .001), nonabdominal emboli (P = .001), and a greater number and larger vegetation (>15 mm, P = .049) in the mitro-aortic valves (P = .051) than patients with normal abdominal CT. The site of acquisition, clinical characteristics, microbiology, surgical treatment, days of hospitalization, hospital death, and 1-year mortality were similar in patients with and without SRL emboli on CT. In the stepwise logistic regression analysis, male gender (odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.4–9.1), liver disease (OR = 8.3, 95% CI = 2.1–31.8), and nonabdominal emboli (OR = 5.2, 95% CI = 2.3–11.7) were independently associated with SRL lesions.Male patients with native LS-IE who had liver disease and nonabdominal emboli had more frequent abdominal lesions seen on CT. The presence of SRL infarcts on abdominal CT scan performed on patients with LS-IE seems to have poor practical implications, and as a consequence, its realization should only be considered when there are symptoms or signs that suggest them.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis

et al. 2018

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“…The estimated incidence of spleen involvement in the course of IE is 4.8-35% [ 12 ]. The first case of splenic rupture as a complication of IE was reported in 1919 by Lake et al .…”

Section: Discussionmentioning

confidence: 99%

Urgent splenectomy in the course of prosthetic valve endocarditis

Marcinkiewicz¹,

Ostrowski²,

Pawłowski³

et al. 2014

kitp

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We present a case of a 51-year-old male patient hospitalized due to acute coronary syndrome requiring stent implantation to the left main stem. Double antiplatelet therapy was commenced. After 2-3 days, the patient presented with high fever, dyspnea on exertion, pain in the chest, myalgia, and general weakness. Transthoracic (TTE) and transesophageal (TEE) echocardiography revealed abnormal, turbulent flow across the aortic prosthesis, which was probably caused by the presence of a pathological smooth and mobile structure (10 × 9 × 5 mm) in front of the aortic annulus. Blood cultures were positive and staphylococcal prosthetic valve endocarditis (PVE) was diagnosed. Despite antibiotic treatment, the patient's condition deteriorated, and he was referred for prosthesis reimplantation. After being transferred to the Cardiac Surgery Clinic, he presented with nausea, vomiting, and abdominal pain. The results of imaging examinations suggested spleen hematoma. The patient underwent an urgent splenectomy. Histopathological examination revealed a spleen infarction consequent to an embolic event and subscapular hematoma. On the 10th day after the laparotomy, cardiac surgery was performed. No large vegetations were found on the aortic prosthesis. The mechanical valve, implanted 20 years earlier, was functioning properly; it was intact and well healed. Several fragments of a thrombus and fibrous tissue, resembling a pannus and covered with minor calcifications, were removed from the ventricular surface of the discs. A decision was reached to leave the aortic prosthesis in situ. The valvular material culture revealed the presence of Streptococcus anginosus, and the antibiotic scheme was modified. The postoperative period was uneventful.

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“…The microorganisms involved were Streptococcus viridians (44%) and Staphylococcus aureus (15%), a microbiological spectrum similar to that of native valve endocarditis [15]. …”

Section: Discussionmentioning

confidence: 99%