PMC6180892_01
Brain MRI. (a) Axial slice of T
2 weighted dark fluid sequence with fat suppression. One of the multiple small hyperintense lesions is shown in the periventricular area. (b) Axial slice of high-b-value diffusion sequence. The hyperintense signal of the periventricular lesion is noteworthy. (c) Axial image of apparent diffusion coefficient map. The signal intensity of the same periventricular lesion (arrowhead) is low, therefore, consistent with diffusion restriction. ) Axial slices of T
1 weighted sequence (d) before and (e) after contrast administration. The enhancement of the small periventricular lesion depicted in the previous images is noteworthy:the absence of ring pattern indicates that there is no fully formed abscess yet.
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fig1
See Figures 1a-e that show a round, enhancing, focal periventricular lesion (Figure 1e) with diffusion restriction (Figure 1b,c).
Transoesophageal echocardiography. Cross-sectional plane of the intraluminal structure in the ascending aortic graft.
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On transoesophageal echocardiography, an intraluminal structure in the ascending aorta was noted (Figure 2, Supplementary Video A).
Axial slice of CT angiography. The anterior wall of the graft is irregularly thickened with a hypodense component extending into the lumen.
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fig3
For better assessment of the aortic wall, a single-beat prospective ECG-gated helical cardiac CT angiography was performed, which showed thickening and irregularity of the anterior wall of the ascending aortic graft with an intraluminal hypodense formation (Figures 3 and 4).
Curved multiplanar reconstruction of CT angiography. The intraluminal vegetation arises from the thickened wall (asterisk) of the graft.
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fig4
For better assessment of the aortic wall, a single-beat prospective ECG-gated helical cardiac CT angiography was performed, which showed thickening and irregularity of the anterior wall of the ascending aortic graft with an intraluminal hypodense formation (Figures 3 and 4).
Cardiovascular MR. (a) Transaxial steady-state free precession cine of the ascending aorta shows the intraluminal mobile mass. (b) Axial slice of axial spin echo (half-Fourier acquisition single-shot turbo spin-echo) sequence at the same position as the CT image in Figure 3. The irregularly thickened anterior wall of the aortic graft with intraluminal components is noteworthy. (c) Axial slice of gradient echo (true fast imaging with steady-state free precession) sequence at the same position as the previous image confirms the irregularly thickened anterior wall of the aortic graft with vegetation extending into the lumen.
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fig5
Cardiovascular MR study confirmed the ultrasound and CT findings, showing thickened anterior wall of the graft with vegetation-like luminal extension (Figure 5a, Supplementary Video B). The thickened aortic graft lesion and the intraluminal component showed heterogeneous MRI signal intensity, which may reflect an early stage of abscess formation (Figure 5b,c).