Thirteen square centimetre mass causing syncope in a patient with device related infective endocarditis.
A 68-year-old man presented with anorexia, weight loss and severe asthenia starting 2 months before and fever lasting over 2 weeks. Analytical study revealed increased C reactive protein and sedimentation velocity. While thoracic x-ray and urinalysis were unremarkable, blood cultures were consistently positive for Enterococcus faecalis. A thoracic echocardiogram revealed a very large vegetation adherent to the ventricular electrocatheter of the patient's pacemaker, so parenteral antibiotics were started. During his stay at the internal medicine ward, patient suffered three syncopal episodes and maintained intermittent fever. A transesophageal ECG performed at a tertiary centre on the 14th day unmasked a 9-12 cm(2) organised mass, ovoid and with regular borders, adherent to the ventricular electrocatheter at right atrium level and protruding to the ventricle at systole. Patient was referred for cardiothoracic surgery and a 13 cm(2) mass was removed alongside the ventricular electrocatheter. Two weeks following surgery, patient remains stable and asymptomatic.
Department of Cardiology, Coimbra's Hospital Center and University, S. Martinho do Bispo, Coimbra, Portugal.
Sergio
S
Barra
Flavia
F
Semedo
Rui
R
Providencia
Carlos
C
Pinto
D000368:Aged; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000209:etiology / Q000473:pathology; D013293:Enterococcus faecalis; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000209:etiology; D013575:Syncope / Q000209:etiology*