PMC6186373_01
Electrocardiogram showing sinus bradycardia and left ventricular hypertrophy.
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The electrocardiogram (EKG) showed sinus rhythm and left ventricular hypertrophy (Figure 1).
(a, b) Axial contrast-enhanced abdominal CT demonstrates a segmental infarct in the posterior aspect of the left kidney (short thick arrow). (c) Coronal reformatted CT showing infarcted small bowel (long thin arrow). (d) Noncontrast head CT showing a subacute hemorrhagic infarct in the left temporal lobe (short thin arrow).
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An emergent computerized tomography (CT) scan of the abdomen revealed features suggestive of an embolic infarct in the left kidney (Figures 2(a) and 2(b)) and within the mid-one-third of the superior mesenteric artery causing luminal narrowing and also suspected to be extending to the takeoff of small bowel branches. Segmental mural thickening of at least one small bowel loop was noted which strongly favored acute bowel ischemia as a cause of his abdominal pain (Figure 2(c)). CT scan of the head was performed to assess the recent CVA and showed a subacute hemorrhage along the left-sided temporal parenchyma (Figure 2(d)). CT head imaging was obtained from the facility where the patient presented 3 months prior for cerebral hemorrhage and in comparison, to the most recent CT scan of the head, the hemorrhage appeared stable.
Axial, sagittal, and coronal contrast-enhanced CT images of the chest showing a fungal ball in the aortic root adherent to the prosthetic valve (arrows). Ao = aorta; PA = main pulmonary artery; RA = right atrium; LA = left atrium; RV = right ventricle; LV = left ventricle; SVC = superior vena cava.
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CT of the abdomen were also strongly suspicious for large eccentric thrombus in the ascending aortic graft and the aortic root which were further investigated and confirmed with a CT scan of the chest (Figure 3). Cardiology and cardiothoracic surgery were consulted.
Histopathological sample of the aortic graft shows chronic inflammation and fungus with acute angle branching hyphae.
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Histopathological examination of the aortic graft and cusps of the aortic valve revealed chronic inflammation and was also notable for abundant acute angle branching septate fungal hyphae (Figure 4).