复旦大学：《传染病学 Infectious Disease》课程教学资源（MBBS）教案案例（英文）A Rare Endocarditis

Case report A Rare Endocarditis uh both F,201s

A Rare Endocarditis Case Report Ruan Qiaoling Feb, 2015

Case Presentation 30-year-old male Fever with progressive dyspnoea for 2 months Unremarkable medical history Fateh Ali Tipoo Sultan et al. European Journal of Echocardiography(2010)11,E13

Case Report Case Presentation • 30-year-old, male • Fever with progressive dyspnoea for 2 months. • Unremarkable medical history. Fateh Ali Tipoo Sultan et al. European Journal of Echocardiography (2010) 11, E13

Case Presentation On Physical examination: T:38.5C An apical 3/ 6 pansystolic murmur decreased with inspiration and radiating to the axilla consistent with significant mitral regurgitation Bibasilar rales were present in both lungs Grade 2/4 peripheral oedema was noted Fateh Ali Tipoo Sultan et al. European Journal of Echocardiography(2010)11,E13

Case Report On Physical examination: • T:38.5O C • An apical 3/6 pansystolic murmur decreased with inspiration and radiating to the axilla consistent with significant mitral regurgitation. • Bibasilar rales were present in both lungs. • Grade 2/4 peripheral oedema was noted. Case Presentation Fateh Ali Tipoo Sultan et al. European Journal of Echocardiography (2010) 11, E13

Case Presentation Laboratory data Normochromic normocytic anaemia with hb of 99 g/L WBC of 14 000 per mL with 83% neutrophils Serum creatinine of 1.9 mg/dL Serial cardiac enzymes were normal Case report

Case Report Laboratory data: • Normochromic normocytic anaemia with Hb of 99 g/L • WBC of 14 000 per mL with 83% neutrophils • Serum creatinine of 1.9 mg/dL. • Serial cardiac enzymes were normal. Case Presentation

Case Presentation Chest X-ray showed interstitial pulmonary oedema with a small left pleural effusion ECG demonstrated right bundle branch block Case report

Case Report • Chest X-ray showed interstitial pulmonary oedeman with a small left pleural effusion. • ECG demonstrated right bundle branch block. Case Presentation

Case Presentation Transthoracic echocardiogram(tte)showed a mildly dilated left ventricle with normal systolic function( ejection fraction = 60%) A 29*10 mm highly mobile mass was seen attached to the tip of the anterior mitral leaflet with a flail segment of the anterior leaflet The aortic and pulmonic valves were normal Case report

Case Report • Transthoracic echocardiogram (TTE) showed a mildly dilated left ventricle with normal systolic function (ejection fraction = 60%). • A 29*10 mm highly mobile mass was seen attached to the tip of the anterior mitral leaflet with a flail segment of the anterior leaflet. • The aortic and pulmonic valves were normal. Case Presentation

Case Presentation TTE: A highly mobile mass attached to the tip of the anterior mitral valve Color Doppler: Severe mitral regurgitation

Case Report Case Presentation TTE: A highly mobile mass attached to the tip of the anterior mitral valve. Color Doppler: Severe mitral regurgitation

Case Presentation 3. Cardiac surgery was planned on the 5th day of the admission Impression: 2. Empirical vancomycin and Infective Endocarditis amikacin made no improvement 1. Blood cultures( 3 sets)on admission were negative

Case Report 1. Blood cultures (3 sets) on admission were negative. 3. Cardiac surgery was planned on the 5th day of the admission. 2. Empirical vancomycin and amikacin made no improvement. Case Presentation Impression: Infective Endocarditis

Case Presentation ° Operative findings: Multiple, small, dense, yellowish masses in the right atrium with caseating(干酪样) appearance a large vegetation on the friable perforated anterior mitral leaflet with ruptured chordae(腱索) Mitral Valve Vegetation Case report

Case Report • Operative findings: • Multiple, small, dense, yellowish masses in the right atrium with caseating(干酪样) appearance • A large vegetation on the friable perforated anterior mitral leaflet with ruptured chordae (腱索) Case Presentation Mitral Valve Vegetation

Case Presentation The mitral valve was excised and replaced wth31 mm mechanical prosthesis(假体) The dense yellow areas inside the right atrium Were cleaned Patient was uneventful post-operate Culture were negative for bacteria and fungi Histology was non-diagnostic with no definitive granulomas Case report

Case Report • The mitral valve was excised and replaced with 31 mm mechanical prosthesis(假体). • The dense yellow areas inside the right atrium were cleaned. • Patient was uneventful post-operate. • Culture were negative for bacteria and fungi. • Histology was non-diagnostic with no definitive granulomas. Case Presentation