Cardiac magnetic resonance imaging identifies the elusive perivalvular abscess

© 2008 American Heart AssociationA 51-year-old man with known bicuspid aortic valve disease presented with a 3-day history of fever. Examination revealed mixed aortic valve disease (confirmed by transthoracic echocardiography) and microscopic hematuria. He was given intravenous antibiotics, and blood cultures confirmed Staphylococcus aureus infection. The patient subsequently developed first-degree heart block (Figure 1) but both transthoracic echocardiography (Movie I) and transesophageal echocardiography (Movie II) did not identify the clinically suspected perivalvular abscess. His chest x-ray examination was unremarkable except for left ventricular dilatation (Figure 2). However, cardiovascular magnetic resonance (CMR) imaging demonstrated a structural abnormality in the basal septum with surrounding late enhancement after gadolinium administration, which is consistent with a septal abscess (Figure 3).Aaron L. Sverdlov, Karen Taylor, Andrew G. Elkington, Christopher J. Zeitz and John F. Beltram