Precordial abscess inducing chest pain 20 years after surgical repair of a pentalogy of fallot.
A 25-year-old male asylum-seeker presented with chest pain, exertional dyspnea, and orthopnea 20 years after the surgical repair of a pentalogy of Fallot. An extracardiac mass compressing the right ventricle was subsequently detected and surgical decompression was performed to relieve the resulting right intraventricular hypertension. At operation, the mass proved to be a coagulase-negative, staphylococcal abscess. In addition, the removal of the mass unmasked a previously nonrecognized pulmonary outflow stenosis that required balloon dilatation and beta-blocker therapy. While infections are known to occur after sternotomy, the formation of an abscess in the anterior mediastinum several years after the intervention appears to be exceptional; this diagnosis came to mind only after the more common complications had been considered, e.g., pseudoaneurysm or pericardial hematoma. To our knowledge, this is the first report of an abscess in the anterior mediastinum that had probably formed over many years following a sternotomy, compressed the right ventricle and masked a pulmonary stenosis.
Medical Outpatient Clinic, University of Lausanne, Switzerland.
Evelyne
E
Aschwanden
Patrick
P
Bodenmann
Léo
L
Schlueter
Malika
M
Fivat-Arbane
Michel
M
Hurni
Salah Dine
SD
Qanadli
Andres
A
Jaussi
D000038:Abscess / Q000150:complications* / Q000628:therapy; D000328:Adult; D006328:Cardiac Catheterization; D002404:Catheterization; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D012086:Reoperation; D013203:Staphylococcal Infections; D013771:Tetralogy of Fallot / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000628:therapy; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000628:therapy