Cardiovasc Imaging Asia.  2019 Oct;3(4):125-128. 10.22468/cvia.2019.00122.

Multimodality Imaging Features of Cardiac Fungal Infection: A Case Report

• Talib N
• Mohammed Y
• Abas SI
• Ramli KA

• KMID: 2465784
• DOI: http://doi.org/10.22468/cvia.2019.00122

Abstract

We present a 38-year-old man with hepatitis C and history of intravenous drug use who presented with fever and hemoptysis. Initial chest CT showed bronchiectasis with an intracavitary lesion consistent with invasive lung aspergillosis in the background of a previously treated tuberculosis infection. Subsequently, he developed cardiac failure symptoms, and transthoracic echocardiogram revealed a left ventricle (LV) apical lesion mimicking a thrombus or vegetation. However, cardiac MRI suggested a fungating apical lesion in the LV, which showed gradual enhancement at the peripheral lesion while sparing the central core in the first-pass perfusion sequence. The long inversion time (600 milliseconds) of the late gadolinium sequence confirmed presence of persistent peripheral enhancement suggestive of an infective focus rather than a thrombus. The intracardiac lesion was compatible with a left ventricular fungal lesion or aspergilloma consistent with a positive serum galactomannan assay. The patient refused surgical intervention. Despite a long course of antifungal therapy, he succumbed to death three weeks after completion of treatment due to disease complications.

Keyword

Cardiac aspergilloma; Magnetic resonance; Computer tomography; Echocardiography

MeSH Terms

Adult
Bronchiectasis
Echocardiography
Fever
Gadolinium
Heart Failure
Heart Ventricles
Hemoptysis
Hepatitis C
Humans
Magnetic Resonance Imaging
Perfusion
Pulmonary Aspergillosis
Thrombosis
Tomography, X-Ray Computed
Tuberculosis
Gadolinium