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Aquarium sign in sepsis
Rui André Providência1, Paula Mota, Nuno Quintal
1Serviço de Cardiologia, Centro Hospitalar de Coimbra, Hospital Geral, Quinta dos Vales, 3041-801 S. Martinho do Bispo, Coimbre, Portugal. rui_providencia@yahoo.com
Abstract:
A 91-year-old man appeared in our lab with fever for a transthoracic echocardiography assessment. Highly unusual echo images were found, with a size and movement resembling 'bubbles in an aquarium' in every cardiac chamber, both left and right. The patient died 8 days later, due to a methicillin-resistant Staphylococcus aureus sepsis. These are highly unusual images that should not be confused with microbubbles from contrast agents or radiofrequency ablation, and were previously reported once in association with atrioesophageal fistula.
Insights
A rare case of unusual echocardiography findings, resembling
Area of Science:
- Cardiology
- Infectious Disease
- Medical Imaging
Background:
- A 91-year-old male presented with fever requiring transthoracic echocardiography.
- The patient had a history of methicillin-resistant Staphylococcus aureus (MRSA) sepsis.
Observation:
- Transthoracic echocardiography revealed highly unusual echo images.
- These images, described as 'bubbles in an aquarium,' were observed in all cardiac chambers.
- The findings were distinct from contrast-induced microbubbles or radiofrequency ablation artifacts.
Findings:
- The unusual echocardiographic findings were associated with severe MRSA sepsis.
- The patient expired 8 days after the echocardiogram due to sepsis complications.
- This presentation is exceedingly rare, with only one prior report linked to an atrioesophageal fistula.
Implications:
- Highlights the importance of recognizing rare echocardiographic presentations.
- Suggests potential, though unconfirmed, associations between specific sepsis types and unusual cardiac imaging findings.
- Underscores the need for differential diagnosis in complex echocardiographic cases.