Cardiac Infections Seminars in Roentgenology

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Cardiac Infections Seminars in Roentgenology C.A. Ridge, FFRRCSI, D. Litmanovich, MD, R.L. Eisenberg, MD JD Seminars in Roentgenology Volume 52, Issue 1, Pages 43-48 (January 2017) DOI: 10.1053/j.ro.2016.05.007 Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 1 Constrictive pericarditis. A 54-year-old man with a remote history of pulmonary tuberculosis and worsening dyspnea. Axial contrast-enhanced CT images of the chest demonstrate pericardial thickening and calcification, an elongated right ventricle (arrow), and reflux of intravenous contrast into the hepatic veins, suggesting tricuspid regurgitation. Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 2 Myocarditis. A 46-year-old woman with a 1-week history of chest pain and elevated serum troponin. Short axis, 2-chamber view, double inversion recovery CMR image demonstrates late gadolinium enhancement in the left inferolateral basal mid myocardium (arrow). Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 3 Endocarditis and septic pulmonary emboli. A 58-year-old woman with fever, dyspnea, and multiple pulmonary cavities on chest radiography. Axial contrast-enhanced CT demonstrates a 2cm vegetation on the tricuspid valve (A, arrow). CT image of the lungs shows multiple thin-walled pulmonary cavities (B, arrowhead). Additional findings include a left pneumothorax and bilateral lower lobe atelectasis. Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 4 Paravalvular abscess. A 21-year-old woman with a bicuspid aortic valve who presented with fever and positive streptococcal cultures. ECG-gated CT of the thoracic aorta shows calcification of the aortic valve and anterior thickening of the left ventricular outflow tract. Contrast opacifies a 1.5cm channel arising from the right coronary sinus, consistent with an abscess (arrow). Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 5 Periprosthetic abscess. A 35-year-old man with a prosthetic aortic valve who presented with fever. ECG-gated CT of the thoracic aorta shows contrast opacifying a 3cm anterior outpouching from the left ventricular outflow tract consistent with a periprosthetic abscess (arrow), which was subsequently surgically repaired. Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 6 Graft infection and early sternal osteomyelitis. A 46-year-old woman with fever on a background of type A aortic dissection treated with aortic root and arch replacement 5 years previously. ECG-gated, contrast-enhanced CT images show new findings of periaortic vessel wall thickening (A, arrow) and mediastinal fat stranding, anterior mediastinal lymph nodes (measuring up to 1.1cm), and stranding of the presternal subcutaneous fat (B, arrowhead). Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 7 Mediastinitis after cardiac transplantation. A 59-year-old woman who underwent cardiac transplantation for ischemic cardiomyopathy 1 month previously. The sternal wound was unstable to palpation and a purulent wound discharge was noted. Sternal swab cultures were positive for Staphylococcus epidermidis, but blood cultures were negative. Axial unenhanced CT images of the mediastinum show fat stranding in the presternal and mediastinal fat, an anterior mediastinal fluid collection (A, arrow), a bubble of mediastinal gas (B, thin arrow), and a small pericardial effusion. Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 8 Transthoracic echocardiographic images of a 48-year-old man with Crohn disease who presented with sepsis and a longstanding portacath device. (A) TEE confirms a right atrial thrombus (arrow) adjacent to the tip of the central venous catheter. (B) Cardiac CT was obtained using retrospective ECG-gating after intravenous administration of a 1:1 mixture of omnipaque contrast and normal saline to minimize streak artifact of right heart contrast and improve visualization of the right heart lesion. This demonstrates a well-circumscribed, nonenhancing 3.9cm right atrial mass (arrow) adherent to the posterolateral wall, consistent with thrombus. A bubble of air may have been due to infection or indwelling catheter manipulation. (Color version of figure is available online.) Seminars in Roentgenology 2017 52, 43-48DOI: (10.1053/j.ro.2016.05.007) Copyright © 2017 Elsevier Inc. Terms and Conditions