Cardiac Computed Tomography of Severe Aortic Endocarditis
A 37-year-old patient revealed a splenic infarct (Figure 1) after work-up for left-sided chest pain. The patient had a fever of 38°C, a pulse of 55 beats per minute, and a blood pressure of 140/50 mm Hg. Transesophageal echocardiography confirmed an aortic valve graft with abscess of the aortomitral fibrous trigone (Figure 2, Data Supplement Movie I) that complicated a stage IV rheumatic aortic insufficiency (Figure 3). The ECG-gated 64-slice computed tomography revealed a calcified vegetation (Figure 4) on the left coronary cusp with partial destruction of the aortomitral fibrous trigone 16 mm on the large axis at the base of the left and posterior coronary cusps that extended to the base of the mitral ring (Figures 4 and 5⇓). The 3 leaflets were noncongruent and thickened consistent with rheumatic heart disease (Figure 5, Data Supplement Movies II and III). Serology was positive for Bartonella quintana.
The online-only Data Supplement, which contains movies, can be found at http://circ.ahajournals.org/cgi/content/full/116/9/e312/DC1.