P1339 Clinical masks of aortic aneurysm: staged rupture of an aortic aneurysm under the guise of a recurrent infection
Abstract A 63-year-old man was admitted to the medical intensive care unit because of hypotension and suspected sepsis. Two months before he was admitted to military hospital for cerebrovascular event, considered as transient ischemic attack. Few days after discharge the fever (with a temperature of...
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| Published in: | European heart journal cardiovascular imaging Vol. 21; no. Supplement_1 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Oxford University Press
01-01-2020
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| Online Access: | Get full text |
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| Summary: | Abstract
A 63-year-old man was admitted to the medical intensive care unit because of hypotension and suspected sepsis. Two months before he was admitted to military hospital for cerebrovascular event, considered as transient ischemic attack. Few days after discharge the fever (with a temperature of 39.5°C) occurred and patient was readmitted to the same hospital. Empirical treatment with cefalosporine was inefficient. Only combination carbapenem and vancomycin after E.coli was verified in blood culture stopped the infection. With normal body temperature, normal leukocytes count, mild azotemia, sterile blood and urine cultures and diagnosis of treated urosepsis patient was discharged. Two echocardiogram during hospital stay found no abnormal findings and chest CT scan was also normal.
Seven days later, he was seen in our hospital because of fever (with a temperature of 40°C), severe sweating and arterial hypotension. Immediately fluids and norepinephrine infusion was started. Fluoroquinolone was chosen as an antibiotic.
There was complete LBBB on ECG that had been registered previously. Leucocyte count at admission was 14 x 109/l and creatinine 300 µmol/l. Transthoracic echo (TTE) reportedly showed evidence of mild aortic and mitral regurgitations, pericardial effusion (1.0 – 1.3 cm with signs of right atrium compression). Aortic root seemed quite normal. On the third day, the number of leukocytes and creatinine increased significantly, reaching 450 µmol/l and 41 x 109/l respectively. Chest CT scan revealed signs of bilateral pneumonia, pericardial and left-sided pleural effusions. Vancomycin and ceftriaxone intravenously were started. Transesophageal echo revealed degenerative changes of aortic valve with mild insufficiency, mild mitral regurgitation. The amount of fluid in the pericardium was approximately unchanged. Patient became normotensive and norepinephrine infusion was discontinued. On the 6th day after admission patient’s temperature became normal, level of creatinine decreased to 230 µkmol/l and leukocytes reached 11.4 x 109/l. On the same day, the patient"s condition worsened. He complained of mild heartburn and progressive weakness, the number of leukocytes and the activity of transaminases increased, his blood pressure dropped to 75/40 mm Hg. This has led to the resumption of norepinephrine infusion. Repeated CT scan revealed inhomogeneous contents in the pericardium. Repeated TTE found increase of pericardial effusion with heterogenous content and signs of cardiac tamponade. Patient was transferred to operating room. After pericardiotomy multiple blood clots and active bleeding from pseudoaneurysm of ascending aorta were found. Despite surgical attempts and massive transfusion, patient died. Autopsy revealed the rupture of pseudoaneurysm of ascending aorta and flat hematoma in pericardium.
Abstract P1339 Figure. |
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| ISSN: | 2047-2404 2047-2412 |
| DOI: | 10.1093/ehjci/jez319.777 |