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

Tabandeh, Mahmoud; Bahramali, Eshan; Roomi, Zahra Savand; Salari, Soheila; Radpey, Mohammadreza; Shamsolvaezin, Nadereh

doi:10.1016/j.jccase.2019.12.006

Cited by 2 publications

(5 citation statements)

References 10 publications

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“…Cardiac involvement by aspergillus is generally through hematogenous dissemination with very few cases of contiguous spread from the mediastinal disease. [1][2][3][4] Four types of fungal cardiac involvement have been described (a) cardiac aspergilloma presenting as intracavitory lesion, (b) myocardial infarction secondary to embolism of aspergillus hyphae, (c) myocarditis with intra-myocardial abscesses with variable involvement of cardiac layers or pericardium and (d) fungal valvular endocarditis. [1][2][3] Our case highlights cardiac involvement by aspergillus with contiguous spread from mediastinum, as there was no evidence of hematogenous spread on laboratory investigations, clinically patient was not that sick as often seen with hematogenous dissemination of disease and imaging was corroborative.…”

Section: Discussionmentioning

confidence: 99%

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

Sharma

Choudhury

Bahl

et al. 2021

Asian Cardiovasc Thorac Ann

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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.

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Section: Discussionmentioning

confidence: 99%

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

Sharma

Choudhury

Bahl

et al. 2021

Asian Cardiovasc Thorac Ann

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“…First, emboli are more frequent in fungal IE compared to bacterial IE, and their occurrence might offer a clue. These emboli can be related to large fungal vegetations, which are friable and highly mobile [43,52,56,57,76,78,90,93,95,98,99] . Stroke was documented in 29 of the included cases, while splenic, renal, pulmonary, or peripheral embolism were documented in 20 cases.…”

Section: Signs and Symptoms Of Fungal Iementioning

confidence: 99%

“…In the absence of proof of fungal IE, antifungals are not considered till late in the course of disease progression. Rapid diagnosis and treatment for fungal IE are essential for good outcomes [48,83,87,97,98] . Some fungi with low virulence can become widespread before causing symptoms [121] .…”

Section: Signs and Symptoms Of Fungal Iementioning

confidence: 99%

“…A cardiac CT can be needed to demonstrate the vegetation or filling defect [123] or cardiac abscesses [85] . Cardiac MRI can sometimes be necessary for the distinction between invasive aspergilloma and a tumor of the heart [69,98,99] . CT/MRI of other regions is part of the work-up, especially in cases of stroke or infarctions and abscesses of other solid organs.…”

Section: Other Imaging Modalities In Fungal Iementioning

confidence: 99%

“…It was administered in patients with C. parapsilosis [45,46,[49][50][51][52] and other Candida species [63,65,70] or a combination of Candida with a bacterial IE [74,75,77] , but not in patients with C. albicans infection. It has also been applied in several species of Aspergillus [81,82,[84][85][86][87]89,90,92,[95][96][97][98] , one patient with Cryptococcus [100] , all patients with Histoplasma [104][105][106][107] and Trichosporon [109][110][111][112] , as well as in some other fungal species [112,113,116,117,[121][122][123][124] . Nevertheless, it was reduced in dosage in one of the cases [124] and had to be discontinued in two other cases with renal failure [116,121] .…”

Section: Medical Treatment Of Fungal Ie In the Acute Phasementioning

confidence: 99%

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“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis

Mistiaen

2024

Vessel Plus

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Fungal infective endocarditis is a rare but highly lethal condition. Its diagnosis is often delayed due to nonspecific symptoms, inconclusive medical imaging, and negative blood cultures. Recent reviews of cases and series over the last 5 years indicate that the condition remains rare and lethal. If fungi are identified as the causative agents in more than 5% of patient cases with infective endocarditis, it is likely that risk factors such as immune suppression or cardiac implants are probably involved. A series derived from recent case reports indicates that Candida and Aspergillus are still the main causative infectious agents, with. C parapsilosis on the rise. From these cases, diagnostic clues (frequent embolisms, ophthalmic involvement, large, mobile and friable vegetation, non-valvular cardiac manifestations) are pointing towards fungal IE. These reports, however, are not standardized and a publication bias towards rare microorganisms or towards a favorable outcome might exist. Complications might be underreported, and important data such as diagnostic delay are absent or difficult to retrieve. Pharmacologic treatment is not fully standardized. Knowledge of resistant strains in this respect is important. Statistical analysis for the effect of complications and treatment modalities on outcome shows that any result should be treated cautiously. The current series is by no means a valid substitute for a well-designed series of fungal endocarditis. However, the better outcome with Candida and patients treated with surgery confirm earlier results. An international multicentric standardized registry of cases with fungal endocarditis in order to improve the outcome of this disease is highly needed. The effect of diagnostic delay on outcome remains elusive and should be resolved.

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

Cited by 2 publications

References 10 publications

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

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

“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis

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