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Right-sided endocarditis secondary to a peritoneovenous shunt
Jennifer Higgins1, Hossein Shayan, Guy Fradet
1University of British Columbia, Vancouver. jwille@interchange.ubc.ca
The Canadian Journal of Cardiology
|September 18, 2010
Summary
A large right atrial mass, initially suspected to be a tumor, was diagnosed as bacterial endocarditis. Prompt surgical removal and valve replacement were crucial for recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- A 51-year-old woman with a peritoneovenous shunt for refractory ascites developed fatigue, dyspnea, night sweats, and positive blood cultures.
- Imaging revealed multiple pulmonary emboli, suggesting a systemic infectious or embolic process.
Observation:
- Transthoracic echocardiography showed a large pedunculated right atrial mass and moderate tricuspid regurgitation.
- The mass persisted despite antibiotic therapy and anticoagulation, indicating a non-resolving etiology.
Findings:
- Surgical excision revealed the mass to be bacterial endocarditis with extensive bacterial colonies.
- Pathology also showed fibromyxoid changes, consistent with postinflammatory changes on the tricuspid valve.
Implications:
- This case highlights the importance of considering infectious etiologies, such as endocarditis, in patients with unexplained masses and embolic phenomena.
- Early surgical intervention is critical for managing large vegetations and associated valvular damage in infective endocarditis.
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