PMC6530244_01
Chest X-ray on admission (a) compared to the prior chest X-ray (b); black arrows show superior mediastinal fullness compared to the prior study.
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fig1
A chest X-ray as part of the routine work-up was ordered from the emergency room and showed widening of the superior mediastinum compared to his prior film (Figure 1).
CT chest with contrast. White arrows show periaortic abscess in the ascending aorta.
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fig2
Due to this concerning finding, a CT scan of the chest with contrast was ordered and showed a new fluid collection surrounding the ascending aorta and extending into the aortic arch measuring 5 cm in mediolateral dimension at the level of aortic arch (Figure 2).
Mid-esophageal long-axis view of the heart with Doppler in the transesophageal echocardiogram showing severe aortic regurgitation.
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fig3
The TEE showed an echolucent area (Figure 3) consistent with fluid or blood around the ascending aorta conduit graft concerning for periconduit leak or abscess.
Mid-esophageal long-axis view of the heart in the transesophageal echocardiogram. White arrow shows periaortic abscess extending to the root of the aorta.
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fig4
It also revealed moderate-to-severe aortic regurgitation (Figure 4) with global left ventricular hypokinesis, but no valvular or perivalvular vegetations concerning for endocarditis.