title: Heart blockage in a patient with cavitary lung lesions.
abstract: Cavitary lesions on a chest radiograph can be the manifestations of various diseases. The etiologies include abscess, mycobacterial infections, fungal infections, parasite infection, cavitary tumors, septic pulmonary embolism and vasculitis. While in comparison with the causes that could simultaneously develop a complete heart block, the differential diagnosis is limited. A 43-year-old man presented to the emergency department with a two-week history of dry cough, chest tightness and presyncopal symptoms.A chest radiograph showed patchy opacities in both lower lungs. A computed tomography of the chest revealed cavitary lesions bilaterally. The electrocardiogram showed a complete atrioventricular block. He was later diagnosed with Wegener's granulomatosis that involved nose, lung and heart. Cardiac involvements are not rare in Wegener's granulomatosis, but are not usually clinically apparent. A complete atrioventricular block is a rare but treatable manifestation of cardiac involvement usually indicating early active systemic disease. Patients presenting with cardiac abnormalities and evidence of systemic inflammation should be screened for Wegener's by history, radiographic and laboratory assessment.
authors.affiliation: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Ching-Hsiang
authors.initials: CH
authors.lastname: Lin
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Tsai
authors.forename: Hsiang-Cheng
authors.initials: HC
authors.lastname: Chen
authors.forename: Sy-Jou
authors.initials: SJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D054537:Atrioventricular Block / Q000209:etiology*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D014890:Granulomatosis with Polyangiitis / Q000150:complications*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography