Thrombus or vegetation?Importance of cardiac MRI as a diagnostic tool based on case report and literature review

Ouazzani, Jamal El; Jandou, Issam; Thuaire, Christophe

doi:10.1016/j.amsu.2020.12.007

Cited by 15 publications

(8 citation statements)

References 13 publications

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“…With vegetation, endocardial LGE and a marginal mass enhancement are seen. With thrombus, phase-sensitive inversion recovery sequences reveal an increased central intensity at the lower inversion time, an etched appearance at moderate inversion time, and a decreased intensity at a longer time [14]. Patients with S. constellatus bacteremia need to be worked up for possible abscess collections with imaging of the abdomen, chest, and brain.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus constellatus Left Ventricular Apical Mural Infective Endocarditis With Acute Stroke, Septic and Cardiogenic Shock

Hilker¹,

Patil²,

Holliday³

et al. 2022

Cureus

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Infective endocarditis (IE) is a severe infection of the endocardium and cardiac valves by multiple etiologic agents. Clinical presentation can be acute or subacute based on the host immunity and the causative agent's virulence. Although Streptococci are responsible for most community-acquired native valve bacterial IE, Streptococcus constellatus is an infrequent cause. S. constellatus can rarely infect prosthetic cardiac valves. A middle-aged white male with poorly controlled type 2 diabetes mellitus was transferred to our facility for suspected stroke with an initial presentation of acute encephalopathy of uncertain duration. Transthoracic echocardiogram revealed a left ventricular apical mural vegetation, and brain imaging displayed multiple white matter hypodensities indicative of numerous small strokes. Blood cultures were positive for S. constellatus. Clinical presentation was unusual with an acute encephalopathy due to multiple septic emboli and primary mural IE with high-grade bacteremia due to S. constellatus. PubMed medical literature review reveals this to be a rare clinical presentation by an uncommon etiological agent with an infrequent echocardiogram finding.

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Section: Discussionmentioning

confidence: 99%

Streptococcus constellatus Left Ventricular Apical Mural Infective Endocarditis With Acute Stroke, Septic and Cardiogenic Shock

Hilker¹,

Patil²,

Holliday³

et al. 2022

Cureus

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“…Besides, in low-and-middle-income countries (LMICs), patients are often under antibiotic treatment before admission [ 5 ], which might cause negative blood cultures. Multimodality imaging should be considered to improve diagnostic capabilities [ 2 , 6 ].…”

Section: Clinical Discussionmentioning

confidence: 99%

Multimodality imaging in the diagnosis of bioprosthetic aortic valve endocarditis: A case report

Bui

Duong

Vu³

et al. 2022

Annals of Medicine &Amp; Surgery

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“…By assessing early and late gadolinium levels CMR can help determine if the RHT is related to thrombus or an alternative diagnosis such as tumor or infective endocarditis. 7,8 CMR has been shown to be more sensitive and specific for LV thrombus when compared with TTE or TEE, this likely is true for RV thrombus; however, additional studies are required to confirm this. 9 RHT may be acute, subacute, or chronic depending on the underlying etiology, and direct comparison with prior imaging can be helpful to determine if the RHT was previously present.…”

Section: Pathophysiologymentioning

confidence: 95%

“…In addition to CTA‐PE and echocardiography, cardiac magnetic resonance imaging (CMR) can play a valuable role in further identifying and characterizing RHT 6 . By assessing early and late gadolinium levels CMR can help determine if the RHT is related to thrombus or an alternative diagnosis such as tumor or infective endocarditis 7,8 . CMR has been shown to be more sensitive and specific for LV thrombus when compared with TTE or TEE, this likely is true for RV thrombus; however, additional studies are required to confirm this 9 …”

Section: Pathophysiologymentioning

confidence: 99%

Right heart thrombi (RHT) and clot in transit with concomitant PE management: Approach and considerations

et al. 2022

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Right heart thrombi (RHT) continues to pose a clinical dilemma for multiple specialties and is especially concerning when present with concomitant pulmonary embolism (PE). Patients with PE and RHT are at an increased risk of poor outcomes compared to PE without RHT. Although the exact incidence of RHT is unknown, the increasing use of point-of-care ultrasound may lead to an increased detection and frequency of RHT. There are multiple treatment strategies available for RHT, including anticoagulation, systemic thrombolysis, and endovascular and surgical therapies. Given that these treatment strategies involve multiple medical specialties, the management of RHT with concomitant PE can be complex. Currently, there is limited clinical data and guidelines on the treatment and management of RHT. We aim to provide a review on RHT with concomitant PE, including risk stratification, treatment considerations, and our approach to the management of RHT.

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Thrombus or vegetation?Importance of cardiac MRI as a diagnostic tool based on case report and literature review

Cited by 15 publications

References 13 publications

Streptococcus constellatus Left Ventricular Apical Mural Infective Endocarditis With Acute Stroke, Septic and Cardiogenic Shock

Streptococcus constellatus Left Ventricular Apical Mural Infective Endocarditis With Acute Stroke, Septic and Cardiogenic Shock

Multimodality imaging in the diagnosis of bioprosthetic aortic valve endocarditis: A case report

Right heart thrombi (RHT) and clot in transit with concomitant PE management: Approach and considerations

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