Infected Right Ventricle Thrombus as a Cause of Persistent Sepsis

Abstract

The presentation of fevers in a patient with active intravenous (IV) drug use is often challenging, as there is a wide range of both infectious and noninfectious disorders that can cause fevers. A thorough diagnostic workup is essential in identifying the etiology of these fevers. We report a rare case of an infected right ventricular (RV) thrombus as a cause of persistent fever and sepsis in a 46-year-old patient with IV drug use. The patient continued to have persistent bacteremia inspite of appropriate IV antibiotics. Hence, the patient warranted a cardiothoracic surgical excision of the infected RV thrombus following which the patient showed remarkable improvement.

Keywords: cocaine; infected cardiac thrombus; intravenous drug user; mssa bacteremia; sepsis; surgical resection.

Figure 1. Transthoracic echocardiogram apical four-chamber view showing hazy density in the cavity of the right ventricle (RV) suggestive of a mass along with left ventricle (LV).

Figure 2. Transesophageal echocardiogram mid esophageal view showing a clearer echogenic density in the cavity of the right ventricle (RV) measuring 31 x 20 mm suggestive of a mass along with right atrium (RA), left ventricle (LV), and left atrium (LA).

Figure 3. Bright blood two-chamber view image from a cardiac magnetic resonance study demonstrates a mass that appears attached to the inferior wall of the right ventricle (RV mass) measuring 30 x 17 x 23 mm along with the left ventricle (LV).

Figure 4. Bright blood outflow tract image from a cardiac magnetic resonance study demonstrates a mass attached to the inferior wall of the right ventricle (RV mass) measuring 30 x 17 x 23 mm along with the pulmonary artery (PA) and aorta.