[Myocardial abscess of the right ventricle anterior wall]

The authors report the clinical case of a 63 old male, with a previous history of aortic mechanical replacement valve, who was admitted with fever, neutrophilic leukocytosis and c-reactive protein elevation. During admission Escherichia coli was cultured from blood, and the patient underwent repeated transthoracic and transesophageal echocardiograms, that did not reveal any abnormalities. Three weeks after admission, a new transesophageal echocardiogram showed an image suggestive of an aortic annular abscess. The patient was transferred to the Cardiothoracic Department of Santa Maria Hospital, in order to be submitted to surgical treatment. During the procedure an abscess in the anterior wall of right ventricle was diagnosed. The microbiological cultures of pus were negative. It was assumed the diagnosis of E. coli myocardial abscess. The diagnostic approach to patients with febrile syndrome and mechanical replacement valve should consider the hypothesis of infectious endocarditis and myocardial abscess, despite the rarity of its occurrence.