Case Report
 
ST segment elevations and a pocket full of pus
Aniket S. Rali1, Tarun Dalia2, Aditya Rali3, Xiuxu Chen4, Ivan Damjanov4, Kamal Gupta1
1University of Kansas Medical Center, Division of Cardiovascular Diseases, Kansas City, USA
2University of Kansas Medical Center, Department of Internal Medicine, Kansas City, USA
3Emory University, School of Medicine
4University of Kansas Medical Center, Department of Pathology, Kansas City, USA

Article ID: 100880Z01AR2018
doi: 10.5348/100880Z01AR2018CR

Corresponding Author:
Aniket S. Rali MD,
3901 Rainbow Blvd MS 3006,
Kansas City, KS 66160, USA

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How to cite this article
Rali AS, Dalia T, Rali A, Chen X, Damjanov I, Gupta K. ST segment elevations and a pocket full of pus. Int J Case Rep Images 2018;9:100880Z01AR2018.


ABSTRACT

Introduction: Very few cases of myocardial abscess are reported in medical literature. Although a rare disease entity in the developed countries, it carries a very high mortality rate and hence requires prompt diagnoses and treatment. Here we report a case of myocardial abscess diagnosed on autopsy.
Case Report: A 47-year-old patient with complaints of progressively worsening shortness of breath, abdominal pain and chest pressure from three days. Electrocardiography showed ST segment elevations in leads I, II, III, aVR, aVL, V2-V6. Emergency room team suspected ST segment elevation myocardial infarction (STEMI) and cardiology department was consulted for emergent cardiac catheterization. Due to high clinical suspicion of severe sepsis, the decision was made to hold off on cardiac catheterization. The patient was transferred for emergent computed tomography scan to rule out intra-abdominal infection. While in the scanner, patient developed pulseless electrical activity (PEA) arrest and passed away despite attempted resuscitation.
Conclusion: Myocardial abscess should be considered in patients presenting with conduction defects and ST segment elevations on ECG in the setting of suspected bacteremia or endocarditis. Transthoracic echocardiogram, transesophageal echocardiogram and nuclear medicine scans can all contribute to timely diagnoses. Definitive treatment of myocardial abscess involves surgical drainage. Due to high mortality associated with this disease, prompt diagnoses and treatment is of utmost importance.

Keywords: STEMI, Myocardial Abscess, Pericarditis



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Author Contributions
Aniket S. Rali – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tarun Dalia – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Aditya Rali – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Xiuxu Chen – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ivan Damjanov – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kamal Gupta – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2018 Aniket S. Rali et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.