title: An uncommon cause of pericardial actinomycosis.
abstract: Cardiac actinomycosis is rare; the pericardium is the most frequently involved site, but myocardial, endocardial and valvular involvement have all been documented. Most cases originate from a thoracopulmonary site of actinomycosis and spread directly to the pericardium. Widespread dissemination from extrathoracic organs is uncommon; in fact actinomycosis is prevented by anatomical barriers and hematogenous diffusion is rare. We describe an uncommon case of pericardial actinomycosis due to a draining fistula from the liver to the pericardial space across the diaphragm. The massive dissemination through the fistula could explain the peculiar echocardiographic images of macroscopic, echo-reflective, irregular masses, floating in the pericardial space, probably consistent with aggregates of sulfur granules.
authors.affiliation: Department of Cardiology, Bassini Hospital, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Esposti
authors.forename: A
authors.initials: A
authors.lastname: Lippolis
authors.forename: M
authors.initials: M
authors.lastname: Cipolla
authors.forename: M
authors.initials: M
authors.lastname: Bonazzi
mesh_terms: D000196:Actinomycosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005402:Fistula / Q000150:complications; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010496:Pericardium