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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Related Experiment Video

Updated: Apr 14, 2026

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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A chest wall pulsating mass.

Catarina Patrício1, Rita Ribeiro1, Rui Malheiro1

  • 1Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.

BMJ Case Reports
|April 26, 2015
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Summary
This summary is machine-generated.

A patient with HIV and intravenous drug use developed a sternal abscess and endocarditis. Prompt treatment with antibiotics and drainage led to clinical resolution of Staphylococcus aureus infection.

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Area of Science:

  • Infectious Diseases
  • Cardiology
  • Trauma Surgery

Background:

  • Intravenous drug use is a significant risk factor for Staphylococcus aureus infections, including endocarditis and osteomyelitis.
  • Sternal fractures can predispose to deep-seated infections, particularly in immunocompromised individuals.
  • HIV infection can alter the immune response and increase susceptibility to severe bacterial infections.

Observation:

  • A 34-year-old HIV-positive man with a history of intravenous drug use and recent sternal fracture presented with fever and a pulsatile presternal mass.
  • CT imaging revealed a large abscess with presternal and retrosternal extension, cardiac contact, and necrotizing pulmonary lesions.
  • Blood cultures and abscess aspirate confirmed methicillin-sensitive Staphylococcus aureus, and transesophageal echocardiography identified tricuspid valve endocarditis.

Findings:

  • The patient was diagnosed with right-sided endocarditis, acute sternal osteomyelitis, and septic pulmonary emboli.
  • Treatment involved drainage of the thoracic wall abscess and a 6-week course of intravenous antibiotics (flucloxacillin and gentamicin).

Implications:

  • This case highlights the complex interplay between HIV, intravenous drug use, trauma, and severe bacterial infections.
  • Early recognition and aggressive management, including surgical drainage and targeted antibiotics, are crucial for favorable outcomes in such cases.
  • The pulsatile nature of the presternal mass due to cardiac contact underscores the importance of thorough clinical examination and advanced imaging.