Eustachian valve endocarditis caused by Streptococcus viridans

Right-Sided Endocarditis involving Eustachian Valve Following the Use of a Central Venous Line

Patient: Male, 27-year-old

Final Diagnosis: Endocarditis

Symptoms: Fever

Medication: —

Clinical Procedure: Transesophageal echocardiogram

Specialty: Cardiology • Gastroenterology and Hepatology • Nephrology

Actinomycotic endocarditis of the eustachian valve: a rare case and a review of the literature

Eustachian valve endocarditis caused by Actinomyces species is extremely rare. A literature review revealed only one reported case-caused by Actinomyces israelii in an intravenous drug abuser. Our patient, a 30-year-old woman who at first appeared to be in good health, presented with fever, a large mobile mass on the eustachian valve, and extensive intra-abdominal and pelvic masses that looked malignant. Histopathologic examination of tissue found in association with an intrauterine contraceptive device revealed filamentous, branching microorganisms consistent with Actinomyces turicensis. This patient was treated successfully with antibiotic agents. In addition to presenting a new case of a rare condition, we discuss cardiac actinomycotic infections in general and eustachian valve endocarditis in particular: its predisposing factors, clinical course, sequelae, and our approaches to its management.

Role of transthoracic and transesophageal echocardiography in right-sided endocarditis: one echocardiographic modality does not fit all

The added value of transesophageal echocardiography (TEE) over transthoracic echocardiography in the assessment of left-sided infective endocarditis has been extensively validated in the literature. Little research has dealt with the role of echocardiography in right-sided infective endocarditis (RSE), however. In this review, the differences between RSE and left-sided endocarditis and the different types of RSE according to the types of patients who have the disease are described. Both issues have important implications for echocardiographic workup. Moreover, a systematic echocardiographic protocol to avoid missing right-sided vegetations and several specific morphologic aspects of RSE are reviewed. Normal right-sided structures, which may mimic vegetations, particularly when the clinical picture is compatible, are described. Finally, the value of transthoracic echocardiography and TEE in RSE is reviewed according to the publications available. The diagnostic yield of transthoracic echocardiography is comparable with that of TEE in intravenous drug users. On the contrary, TEE is mandatory in patients with cardiac devices. A Bayesian-based diagnostic approach is proposed for a third poorly characterized group of patients with RSE who are not drug addicts, have no cardiac devices, and have no left-sided endocarditis (the "three no's" endocarditis group).

Eustachian valve endocarditis: Rare case reports and review of literature

Eustachian valve endocarditis (EVE) is a distinctly rare and underdiagnosed entity. We report 2 new cases caused by vancomycin resistant Staphylococcus aureus and Staphylococcus hominis diagnosed on transesophageal echocardiography (TEE). Although, 63% of Eustachian valve endocarditis is caused by Staphylococcus aureus, we report the first case of vancomycin resistant Staphylococcus aureus and first case related to implantable venous access systems. EVE is now seen more commonly in elderly population with diverse microbial cultures and antibiotic sensitivities. TTE is the first modality for investigation of EVE, however a negative TTE does not preclude the diagnosis, as only 88% of cases were diagnosed on TEE.

Noncatheter-associated vegetative phlebitis of the superior vena cava presenting with multiple lung abscesses

We present a patient with a large vegetation in the superior vena cava (SVC) presenting with multiple staphylococcal lung abscesses. We believe that this is the first reported case of vegetative phlebitis of the SVC without a history of central venous catheter line. Our case emphasizes the need for careful imaging SVC using transesophageal echocardiography in bacteremic patients even in the absence of a central catheter.

Eustachian valve endocarditis: a rare localization of right side endocarditis. A case report and review of the literature

BACKGROUND

Right-sided endocarditis occurs predominantly in intravenous drug users, in patients with pacemaker or central venous lines and in patients with congenital heart disease. The vast majority of cases involve the tricuspid valve. Eustachian valve endocarditis is an uncommon disease with similar signs and symptoms of the tricuspid valve endocarditis. A series of only 16 cases of eustachian valve endocarditis are reported in the literature.

CASE PRESENTATION

We present a case of a 25-year old woman with intravenous drug abuse who had a staphylococcus aureus tricuspid valve endocarditis associated to eustachian valve endocarditis. Transthoracic echocardiography, as first line examination, showed the vegetations on tricuspid and eustachian valve.

CONCLUSION

Our case describe an unusual location of right side endocarditis in a intravenous drug abuser. In our case, in accord with other cases described in the literature, transthoracic echocardiography disclosed eustachian valve endocarditis. Antimicrobial management is not altered by the recognition of eustachian valve endocarditis. Antibiotic treatment and duration of eustachian endocarditis depends on the isolated organism and is similar to antibiotic therapy used in native valve endocarditis.