Abstract

Background: Aortic root abscess (ARA) is a serious complication of infective endocarditis (IE) which requires urgent/emergent surgery. ARA has high intra-operative mortality, estimated to be as high as 12%. ARA does not always have specific symptoms, so a high index of suspicion from clinicians is key for diagnosis.

Case presentation: A 53-year-old male with a past medical history of type A aortic dissection (AD) status post repair one year prior to presentation, chronic foot wound and hypertension presented to the Emergency Department (ED) with substernal chest pain radiating to his back and neck. He also reported an episode of syncope at home. In ED, he was found to be hypoxic. Initial Computed Tomography chest was done without contrast due to elevated creatinine and was negative for pulmonary embolism (PE). Ventilation/perfusion scan showed low probability of PE and blood cultures came back positive for grampositive cocci, eventually specified as methicillin resistant staphylococcus aureus (MRSA). Repeat CT chest with contrast showed fluid collection near the aortic arch and he was diagnosed with an ARA. He was initially treated with drainage of the abscess by interventional radiology (IR) and was transferred to another facility for surgical management.

Conclusion: Although infective endocarditis (IE) is routinely managed with medical therapy alone, ARA is an indication for surgery. Patients with ARA are often critically ill and at risk for many disastrous complications, including acute congestive heart failure (CHF), septic shock, fistula formation, and involvement of the mitral valve. It is integral to promptly diagnose this condition so patients may receive proper treatment and care.

Keywords: Infective endocarditis (IE); Aortic root abscess (ARA); Peri-Annular abscess