PMC2825769_01
Abdominal computed tomography scan showing multiple ischemic areas (arrows) in the right kidney (a) and in the spleen (b), suggesting an embolic source.
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Abdominal computed tomography scan revealed multiple ischemic areas in the spleen and in the right kidney (Figures 1(a) and 1(b)), suggesting an embolic source.
(a) Transesophageal echocardiogram (TEE) image of the proximal descending aorta (PDA) with sectioning plane at 0 . A large polypoid sessile vegetation (2.1 x 0.9 cm) attached to the intima can be seen at the beginning of descending thoracic aorta (arrow); (b) TEE image of the PDA with sectioning plane at 117 , showing the same vegetation (arrow).
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Transesophageal echocardiogram (TEE) revealed a large (2.1 x 0.9 cm) polypoid sessile vegetation with highly emboligenic characteristics at the beginning of descending thoracic aorta, suggesting infectious thoracic aortitis (Figures 2(a) and 2(b)).
Thoracic MRI performed before surgery, showing normal dimensions of the thoracic aorta (a) and a repletion defect (arrow) in the aortic arch-descending thoracic aorta transition compatible with a vegetation (b).
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TEE performed 4 weeks later showed no significant change in vegetation size (1.8 x 0.9 cm) and it was decided to perform surgical treatment (40th day of hospitalization). Thoracic magnetic resonance imaging (MRI) was performed before surgery, showing normal dimensions of the thoracic aorta and a repletion defect in the aortic arch-descending thoracic aorta transition compatible with a vegetation (Figures 3(a) and 3(b)).
Intraoperative image of the affected thoracic aortic segment with the vegetation (arrow).
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The affected aortic segment (Figure 4) was ressected with interposition of an aortic conduit (24 mm).
TEE image of the PDA, with sectioning plane at 0 , performed 4 weeks after surgery and before the discharge, showing the aortic conduit (arrow); (left) with a normal colour doppler flow (right).
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TEE performed before hospital discharge showed no changes besides the presence of the aortic conduit (Figure 5).