Right-sided infective mural endocarditis complicated by septic pulmonary embolism and cardiac tamponade caused by MSSA

Wu, Weifang; Ye, Si-kang; Chen, Ge Hui

doi:10.1016/j.hrtlng.2018.05.010

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…The impact of cardiovascular complications, such as valvular damage, cardiac abscess, conduction abnormalities, and stroke on IE outcomes are well-studied [1][2][3][4][5]. However, a recent literature search regarding the effect and management of pulmonary complications (empyema, lung abscesses, and septic pulmonary emboli) on outcomes of IE consists mainly of case reports [6][7][8][9][10][11][12][13][14][15]. There are no large scale epidemiological, retrospective, or prospective studies on the subject and the epidemiology of IE-PC is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

et al. 2021

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Background The impact of cardiovascular and neurologic complications on infective endocarditis (IE) are well studied, yet the prevalence and significance of pulmonary complications in IE is not defined. To better characterize the multifaceted nature of IE management, we aimed to describe the occurrence and significance of pulmonary complications in IE, including among persons with IE related to drug use. Methods Hospitalizations of adult (≥18 years old) patients diagnosed with IE were identified in the 2016 National Inpatient Sample using ICD-10 codes. Multivariable logistic and linear regression were used to compare IE patient outcomes between those with and without pulmonary complications and to identify predictors of pulmonary complications. Interaction terms were used to assess the impact of drug-use IE (DU-IE) and pulmonary complications on inpatient outcomes. Results In 2016, there were an estimated 88,995 hospitalizations of patients diagnosed with IE. Of these hospitalizations,15,490 (17%) were drug-use related. Drug-use IE (DU-IE) had the highest odds of pulmonary complications (OR 2.97, 95% CI 2.50, 3.45). At least one pulmonary complication was identified in 6,580 (7%) of IE patients. DU-IE hospitalizations were more likely to have a diagnosis of pyothorax (3% vs. 1%, p<0.001), lung abscess (3% vs. <1%, p<0.001), and septic pulmonary embolism (27% vs. 2%, p<0.001). Pulmonary complications were associated with longer average lengths of stay (CIE 7.22 days 95% CI 6.11, 8.32), higher hospital charges (CIE 78.51 thousand dollars 95% CI 57.44, 99.57), more frequent post-discharge transfers (acute care: OR 1.37, 95% CI 1.09, 1.71; long-term care: OR 2.19, 95% CI 1.83, 2.61), and increased odds of inpatient mortality (OR 1.81 95% CI 1.39, 2.35). Conclusion and relevance IE with pulmonary complications is associated with worse outcomes. Patients with DU-IE have a particularly high prevalence of pulmonary complications that may require timely thoracic surgical intervention, likely owing to right-sided valve involvement. More research is needed to determine optimal management strategies for complications to improve patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

et al. 2021

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“…Isolated RVME is an unusual type of IE, 4 , 5 occurring in association with predisposing factors but also in previously healthy individuals as this patient. 10 A hypothetical mechanism refers to the RV moderator band where trabeculations could act as a nidus for infection, 11 similar as the location for vegetations in this case. Endocarditis was not considered in the absence of risk factors and unremarkable cardiac examination.…”

Section: Discussionmentioning

confidence: 99%

Case report on right ventricular mural endocarditis, not diagnosed clinically, but histopathologically after cardiac surgery

Díaz-Navarro

Kerkhof

2022

European Heart Journal - Case Reports

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Background Right ventricular mural endocarditis (RVME) is an extremely rare type of infective endocarditis that can occur even in the absence of predisposing factors. The diagnosis is a challenge when no causative pathogen can be detected. Case summary A previously healthy young man was admitted to a local hospital with a diagnosis of prolonged febrile syndrome and treated for acute sinusitis. As complaints returned, he was hospitalized 3 weeks later, where an echocardiogram demonstrated multiple mobile masses in the right ventricle, and a computed tomography scan revealed extensive pulmonary thromboembolism. During surgery, the endocardial masses were excised, and the pathologist considered an inflammatory myofibroblastic tumour. Despite appropriate medication and initial improvements, the complaints persisted, and 2 weeks after the surgery, the patient returned to the hospital. Imaging studies documented reappearance to the previous findings, whereas blood cultures remained negative. During the second surgery, the new masses resembling vegetations were excised, and histologic analysis indicated infective endocarditis. Adjusted medication was given for 30 days. Just before discharge, no vegetations were seen. At follow-up, 5 years later, he was in a healthy condition. Discussion Despite careful examinations, initial treatments according to standard protocols were unsuccessful. At final discharge, the patient reported that a tattoo complication prior to the first hospitalization was treated by antibiotics but that he did not complete the course. This omission in the communication further complicated the diagnostic and management processes, leading to surgical interventions that could have been prevented if the neglected antibiotic course was properly disclosed.

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“…Septic pulmonary embolism (SPE) is a type of nonthrombotic pulmonary embolism. The right cardiac vegetation repeatedly falls off and enters the pulmonary artery and its branches, causing a pulmonary infarction and metastatic abscesses [ 16 ]. Pulmonary embolisms occur in 47.8% of cases of right-sided IE, and lung abscesses occur in 15.5% [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Vascular Complications of Infective Endocarditis: Diagnosis and Management

Ibtisam¹,

Bekkaoui²,

Skiker³

et al. 2021

Cureus

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Right-sided infective mural endocarditis complicated by septic pulmonary embolism and cardiac tamponade caused by MSSA

Cited by 6 publications

References 23 publications

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

Case report on right ventricular mural endocarditis, not diagnosed clinically, but histopathologically after cardiac surgery

Vascular Complications of Infective Endocarditis: Diagnosis and Management

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