Mycotic Aneurysm of the Right Coronary Artery Presenting as Infected Pericardial Effusion
We report a case of a 67-year-old man with a known history of multivessel coronary artery disease who presented with shortness of breath.
His previous angiogram, performed 5 years earlier, showed disease in the left anterior descending artery, trifurcation marginal artery, and a chronically occluded right coronary artery. He declined surgery at that time.
On presentation, he complained mostly of shortness of breath worsening over the last week, associated with nausea and vomiting. He also reported subjective fever and chills but denied weight loss or night sweats.
His initial evaluation, including an ECG and cardiac enzymes, did not show evidence of acute coronary syndrome, but a computed tomography of the chest showed a significant pericardial effusion (Figure 1). His white blood cell count was elevated at 15 000 with 78% neutrophils. His erythrocyte sedimentation rate was also …