A series of cardiac delayed complications following right upper quadrant trauma

Le résumé fourni par la source

A 57-year-old female was referred to emergency room with progressive dyspnoea and intermittent fever. Transthoracic echocardiography revealed a highly mobile, irregular mass (3.9 × 2.2 cm) in the right heart (Panel A, see yellow arrow), and a suspicious mass in the in right pulmonary artery (Panel B, see blue arrow). Unexpectedly, CT demonstrated a 10 cm slender, linear hyperdensity with radiating artefacts traversing from right atrium (RA) to the liver, indicated a metallic foreign body (Panels C–E, see red arrow), along with embolism in the right pulmonary artery (Panel F, see blue arrow). Further history elicited prior trauma: 2 years ago, a lawn mower projectile struck her right upper quadrant, causing transient syncope and a minor, unattended wound. Intra-operative transoesophageal echocardiography noted the hypoechoic mass in both right heart and coronary sinus (Panel G, see yellow arrow), with a concurrent abnormal hyperechoic signal (Panel H, see red arrow), consistent with a metallic foreign body. Intra-operative findings confirmed an elongated metallic foreign body within the coronary sinus (Panels I and J, see red arrow; Supplementary data online, Video S1), covered by vegetations (Panels K, see yellow arrow) extended into RA, tracking along the external surface of the inferior vena cava to the diaphragmatic region and liver. A whitish embolus (2.0 × 2.0 × 2.5 cm) (Panel K, see blue arrow) was removed from the right pulmonary artery. Histopathology confirmed fungal vegetation with abundant hyphae (Panel L). The patient was discharged uneventfully 2 weeks post-operatively. This is a rare case of severe delayed multisequential cardiac complications following abdominal trauma. Immediate complications were remarkably minimal, as the foreign body miraculously avoided all critical structures, with no visceral injury, haemorrhage, or pneumothorax. However, exogenous fungi introduced by the object led to severe delayed complications, primarily cardiac colonization with large vegetations, complicated by pulmonary embolism. Multimodality imaging was critical for diagnosis and management, underscoring the need for vigilant long-term follow-up after trauma and the value of meticulous history taking in patients with unexplained fever and cardiac masses.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.