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CASE REPORT
Intraoperative transoesophageal echocardiographic diagnosis and successful management of mycotic aortitis and pseudoaneurysm
  1. Chong Oon Tan,
  2. Laurence Weinberg,
  3. Parameswan Pillai,
  4. Jon Fernandes
  1. Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
  1. Correspondence to Dr Chong Oon Tan, drchongtan{at}gmail.com

Summary

A 38-year-old intravenous drug using man was scheduled for urgent pericardial window surgery to treat pericardial effusion and tamponade. Transoesophageal echocardiography (TOE) during the procedure revealed a minor residual effusion and an atypical heterogenous thickened appearance of the pericardium and adjoining aortic root. Interrogation of the aortic valve with a ‘panning’ manoeuvre from the mid-oesophageal aortic valve short axis view showed a small hypoechoic lesion between the right and non-coronary cusp at the level of the sinus of Valsalva. Postoperative high-resolution contrast CT confirmed the anaesthesia TOE findings of a small pseudoaneurysm. The decision was then made to proceed to formal aortic root replacement after 5 days of directed antibiotic therapy and evidence of an increase in aneurysm size to 2.7 cm on repeat CT angiogram. The patient made a good postoperative recovery and was eventually discharged from the hospital 3 weeks after his second operation.

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