A case of cardiac tamponade due to an isolated abscess in the ascending aorta of a pregnant woman with a history of intravenous substance abuse

Abstract

We describe the case of a 23-year-old white female, 10-12 weeks pregnant, with a history of intravenous drug use and a recently diagnosed pneumonia, who was found deceased in her bed after a night of sleep. Although postmortem serum toxicology tested positive for alprazolam, tetrahydrocannabinol, and morphine, the ultimate cause of death was determined to be cardiac tamponade secondary to an isolated abscess in the ascending aorta. The patient had several risk factors for aortic rupture and cardiac tamponade including intravenous drug use, pneumonia, and pregnancy. However, an autopsy of the patient showed an isolated abscess of the ascending aorta without evidence of infective endocarditis, coronary artery rupture, aortic aneurysm, or aortic dissection making this an unusual case of cardiac tamponade. The aim of this case report is to encourage providers to obtain a tissue culture of any aortic abscesses so that the organisms involved can be identified. The identification of such organisms may help guide antimicrobial treatment in similar presentations in the future.

A Rare Case of Obstructive Shock due to Cardiac Tamponade in a Term Pregnancy

“…Specifically, we address the timely evaluation, resuscitation, and ongoing management necessary to reduce the morbidity and mortality of this condition. Our review of the literature suggests that while asymptomatic pericardial effusions may occur in late pregnancy, there are only 13 case reports of peripartum cardiac tamponade [5][6][7][8][9][10][11][12][13][14][15][16][17] . Reported etiologies are diverse and include autoimmune, infectious, neoplastic, and iatrogenic causes, and all should be considered when encountering a similar patient presentation.…”

“…Our review of the literature suggests that while asymptomatic pericardial effusions may occur in late pregnancy, there are only 13 case reports of peripartum cardiac tamponade. 5 6 7 8 9 10 11 12 13 14 15 16 17 Reported etiologies are diverse and include autoimmune, infectious, neoplastic, and iatrogenic causes, and all should be considered when encountering a similar patient presentation. A singular case reported by Matsuki et al was presumed attributable to preeclampsia with severe features as the patient presented with severe hypertension and proteinuria and no other etiology for pericardial effusion was identified.…”

Evaluation and Treatment of Cardiac Tamponade in a Pregnant Patient

“…Another case was associated with a large anterior mediastinal mass found to be a B-cell lymphoma treated with pericardial drainage and chemotherapy [11]. Other cases of tamponade due to aortic abscess [12], scleroderma [13], and iatrogenic injury [14] have been described. The current case demonstrates the rarity but seriousness of cardiac tamponade and the importance of quick intervention.…”