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European Journal of Echocardiography 2005 6(5):376-378; doi:10.1016/j.euje.2005.05.006
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Copyright © 2005, The European Society of Cardiology

Systemic and pulmonary embolization in a patient with patent ductus arteriosus

Giuliana Cerrutoa,* and Luigi Mancusob

aHospital ‘V. Cervello’ Palermo, Via Ravenna 4, 92019 Sciacca (Sicily), Italy
bHospital ‘V. Cervello’ Palermo, Via G. Cusmano 4, 90100 Palermo (Sicily), Italy

Received 12 October 2004; received in revised form 28 April 2005; accepted after revision 11 May 2005.

gcerr{at}libero.it

* Corresponding author. Tel.: 0916802708.


   Abstract
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 Abstract
Case report
 
We report on a patient with unrecognized patent ductus arteriosus and infective endocarditis of the aortic valve with septic embolization to the right pulmonary artery and the coronary tree.

Keywords: Ductus arteriosus; Infective endocarditis; Embolization


   Case report
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 Abstract
 Case report
 
A 50-year-old woman was admitted to our hospital after a 6-month period of progressive fever, anaemia, haematuria, anorexia and weight loss. Transthoracic echocardiography was performed before hospitalization and was judged to be normal. Chest computed tomography (CT), which had also been previously performed, showed multiple pulmonary lesions (solid lesions with microcavitations) (Fig. 1).


Figure 1
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  		Figure 1 Chest CT scan. Multiple pulmonary solid lesions with microcavitations are seen.

 
The patient's blood pressure was 100/70mmHg. Physical examination revealed a mild systo-diastolic murmur at the left sternal border, which was unknown at the time of admission. The ECG showed sinus tachycardia (Fig. 2). Blood testing was positive for autoantibodies (ANA, Hep2, ANCA). The diagnosis of vasculitis with renal and pulmonary involvement was made and steroid therapy was initiated. Because of persistence of fever a transthoracic echocardiography was performed in our echo-lab, which showed a mobile vegetation on the non-coronary aortic valve cusp. There was no aortic regurgitation.


Figure 2
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  		Figure 2 ECG at admission showing sinus tachycardia.

 
Multiplane transoesophageal echocardiography demonstrated a patent ductus arteriosus that had not been recognized in the previous echo examinations (Fig. 3A,B), and the presence of vegetation (2cm) on the aortic valve cusp was confirmed (Fig. 4). There were also large lesions (most likely vegetations) within the right pulmonary artery and at the bifurcation of the pulmonary trunk (Fig. 5a,b). Blood cultures revealed the presence of Corynebacterium pseudodiphteriticum. Antibiotic therapy was started with initial improvement of her clinical condition. One week later she developed an inferior and posterior myocardial infarction.


Figure 3
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  		Figure 3 Transoesophageal images of the ductus arteriosus (arrow), (A) with and (B) without colour Doppler flow. AO, aorta; RPA, right pulmonary artery.

 


Figure 4
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  		Figure 4 Transoesophageal image of the aortic vegetation (arrow). AR, aortic root; LA, left atrium.

 


Figure 5
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  		Figure 5 Transoesophageal images showing large mobile vegetations within the right pulmonary artery (arrow). AO, aorta; RPA, right pulmonary artery.

 
During chest pain the ECG showed the presence of ST-T segment elevation in the inferior leads and negative T waves in V1-V2 and aVL (Fig. 6A,B). Transthoracic echocardiography showed hypokinesis of the inferior wall and a striking decrease in size of the aortic vegetation. Three days later she died of massive haemoptysis.


Figure 6
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  		Figure 6 ECG during chest pain (A) and the day after myocardial infarction (B).

 

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This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
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Right arrow Articles by Cerruto, G.
Right arrow Articles by Mancuso, L.
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