Multi-Modality Imaging of a Case of Multiple Intra-Cardiac Aneurysms Complicated by Mitral Valve Leaflet Perforation

Abstract

tigue, fever, night sweats, pleuritic chest pains and cough productive of yellow sputum of about two weeks duration. There was a history of tuberculosis contact at home. At this presentation clinical exam revealed a blood pressure of 92/62 mmHg, heart rate of 77 beats per minute, Respiratory rate of 35 breaths/min with Oxygen saturation of 96%. On general exam there was pallor of nails and conjunctiva and peripheral oedema. On systemic exam he was noted to have percussion dullness in the region of middle lobe of the left lung and decrease air entry was noted. There were no crackles reported. Cardiovascular system exam revealed cardiomegaly with displaced apex beat in the 6 th intercostal space mid-axillary line with grade 4/6 pan-systolic murmur in the mitral area. Blood chemistry revealed low Haemoglobin of 9.8 g/dl secondary to iron deficiency, normal white cell count and a raised C-reactive protein at 33 mg/l and normal urea and electrolytes. Klebsiella pneumoniae and Citrobacter Freundii were noted on sputum microscopy, culture and sensitivity. He was treated with Ceftriaxone and Gentamicin for community acquired pneumonia, and subsequently discharged with out-patient cardiac clinic date. He presented again to the same Hospital in late September 2019, where an assessment of congestive cardiac failure was made sec-