RVOT mural and mitral valve endocarditis: A case report

Case report on right ventricular mural endocarditis, not diagnosed clinically, but histopathologically after cardiac surgery

Background

Right ventricular mural endocarditis (RVME) is an extremely rare type of infective endocarditis that can occur even in the absence of predisposing factors. The diagnosis is a challenge when no causative pathogen can be detected.

Case summary

A previously healthy young man was admitted to a local hospital with a diagnosis of prolonged febrile syndrome and treated for acute sinusitis. As complaints returned, he was hospitalized 3 weeks later, where an echocardiogram demonstrated multiple mobile masses in the right ventricle, and a computed tomography scan revealed extensive pulmonary thromboembolism. During surgery, the endocardial masses were excised, and the pathologist considered an inflammatory myofibroblastic tumour. Despite appropriate medication and initial improvements, the complaints persisted, and 2 weeks after the surgery, the patient returned to the hospital. Imaging studies documented reappearance to the previous findings, whereas blood cultures remained negative. During the second surgery, the new masses resembling vegetations were excised, and histologic analysis indicated infective endocarditis. Adjusted medication was given for 30 days. Just before discharge, no vegetations were seen. At follow-up, 5 years later, he was in a healthy condition.

Discussion

Despite careful examinations, initial treatments according to standard protocols were unsuccessful. At final discharge, the patient reported that a tattoo complication prior to the first hospitalization was treated by antibiotics but that he did not complete the course. This omission in the communication further complicated the diagnostic and management processes, leading to surgical interventions that could have been prevented if the neglected antibiotic course was properly disclosed.

Vegetation Attached to the Left Interatrial Septal Surface at the Congenital Location of the Foramen Ovale: A Rare Occurrence

BACKGROUND Non-valvular mural infective endocarditis (IE) is a rare bacterial growth on cardiac walls. Several risk factors have been reported. Echocardiography is an important diagnostic modality for diagnosing vegetation attached to the intracardiac walls. CASE REPORT We present the case of a 57-year-old man admitted with Staphylococcus aureus bacteremia due to an infected tunnelled hemodialyses catheter. Transthoracic echocardiogram did not show any abnormality, but transesophageal echocardiogram (TEE) revealed a 1.7×0.8 cm mobile echo-density attached to the surface of the interatrial septum in the left atrium, where the foramen ovale (FO) exists in utero. The patient was transferred to another facility for re-do sternotomy cardiac surgery, where these findings were confirmed intraoperatively. A biopsy of the mass was taken, which confirmed it to be a vegetation attached to the FO. CONCLUSIONS We report the first case in the literature of vegetation attached to the surface of the interatrial septum in the left atrium at the congenital location of the foramen ovale. There have been no previously reported cases in the literature with such novel imaging findings.