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Images in cardiovascular medicine
Honeycomb interventricular septum: extension of an aortic root abscess
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  1. G Rajesh,
  2. Babu Kanjirakadavath,
  3. V Haridasan
  1. Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
  1. Correspondence to Dr Babu Kanjirakadavath, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India; drbabuk{at}yahoo.co.in

https://doi.org/10.1136/heartasia-2013-010369

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    A 55-year-old man presented with fever of 3 weeks duration. Clinical examination revealed pallor, clubbing, cardiomegaly, an early diastolic murmur and mild hepatosplenomegaly. Laboratory investigations revealed raised C-reactive protein, leucocytosis and microscopic haematuria. Blood culture yielded no growth. Echocardiography showed a multiloculated abscess in the interventricular septum, resembling a honeycomb, extending from the aortic root and projecting into left ventricular outflow tract (figure 1; see online supplementary videos 1 and 2). There was severe aortic regurgitation. Patient was treated as culture negative endocarditis. Successful aortic valve replacement was done after 3 weeks of antibiotic therapy. Operative findings were confirmative.

    Figure 1
    Figure 1

    Transthoracic echocardiogram (apical 4-chamber view, A and B) shows multiloculated abscess (ab) in the interventricular septum, resembling a honeycomb. Parasternal long-axis view (C) shows a calcific nodule (ca) in aortic valve, aortic root abscess and severe aortic regurgitation. Transoesophageal echocardiogram (mid-oesophageal LVOT view, D) shows the abscess projecting into LVOT. Colour Doppler shows severe aortic regurgitation filling the LVOT (E). LVOT, left ventricular outflow tract.

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    Footnotes

    • Contributors GR: substantial contributions to conception and design, acquisition of data or analysis and interpretation of data. BK: drafting the article or revising it critically for important intellectual content. VH: final approval of the version to be published.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.