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A case of cardiac tamponade due to an isolated abscess in the ascending aorta of a pregnant woman with a history of intravenous substance abuse


We describe the case of a 23-year-old white female, 10–12 weeks pregnant, with a history of intravenous drug use and a recently diagnosed pneumonia, who was found deceased in her bed after a night of sleep. Although postmortem serum toxicology tested positive for alprazolam, tetrahydrocannabinol, and morphine, the ultimate cause of death was determined to be cardiac tamponade secondary to an isolated abscess in the ascending aorta. The patient had several risk factors for aortic rupture and cardiac tamponade including intravenous drug use, pneumonia, and pregnancy. However, an autopsy of the patient showed an isolated abscess of the ascending aorta without evidence of infective endocarditis, coronary artery rupture, aortic aneurysm, or aortic dissection making this an unusual case of cardiac tamponade. The aim of this case report is to encourage providers to obtain a tissue culture of any aortic abscesses so that the organisms involved can be identified. The identification of such organisms may help guide antimicrobial treatment in similar presentations in the future.

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  1. Orbach A, Schliamser JE, Flugelman MY, Zafrir B. Contemporary evaluation of the causes of cardiac tamponade: acute and long-term outcomes. Cardiol J. 2016;23:57–63.

    Article  Google Scholar 

  2. Sánchez-Enrique C, Nuñez-Gil IJ, Viana-Tejedor A, De Agustín A, Vivas D, Palacios-Rubio J, et al. Cause and long-term outcome of cardiac tamponade. Am J Cardiol. 2016;117:664–9.

    Article  Google Scholar 

  3. Miyake M, Izumi C, Kuwano K, Honjo G, Matsutani H, Hashiwada S, et al. Cardiac tamponade during transesophageal echocardiography in a patient with infective endocarditis. J Echocardiogr. 2010;8:25–7.

    Article  Google Scholar 

  4. Dickens P, Ho J, Wong KY. Sudden death from ruptured septic myocardial infarct in an intravenous drug addict. Forensic Sci Int. 1995;75:67–72.

    CAS  Article  Google Scholar 

  5. Natarajan B, Stephens JW. Haemorrhagic cardiac tamponade: a rare complication of pneumonia. QJM. Oxford University Press. 2009;102:813–4.

    CAS  Article  Google Scholar 

  6. Sawhney V, Maksunova O, Ahsan S, Ozkor M, Westwood M. Lesson of the month 1: Pericardial mass and cardiac tamponade associated with Mycoplasma pneumoniae. Clin Med (Northfield Il). 2014;14:549–51.

    Article  Google Scholar 

  7. Karve MM, Murali MR, Shah HM, Phelps KR. Rapid evolution of cardiac tamponade due to bacterial pericarditis in two patients with HIV-1 infection. Chest. 1992;101:1461–3.

    CAS  Article  Google Scholar 

  8. Zver S, Kozelj M, Cernelc P. Chlamydia pneumoniae pneumonia with acute hemorrhagic pericarditis in patient with acute leukemia. Haematologica. 1997;82:254.

    CAS  PubMed  Google Scholar 

  9. Marchiori E, Canella C, Hochhegger B, Zanetti G. An uncommon complication of staphylococcal pneumonia: pneumopericardium with cardiac tamponade. Thorax. 2015;70:395–5.

  10. Codsi E, Tweet MS, Rose CH, Arendt KW, Best PJM, Hayes SN. Spontaneous coronary artery dissection in pregnancy. Obstet Gynecol. 2016;128:731–8.

    Article  Google Scholar 

  11. Han S, Ryu KM, Seo PW, Ryu J-W. A case of recurrent aortic rupture associated with Klebsiella pneumoniae pericarditis treated by two separate aortic operations. Korean J Thorac Cardiovasc Surg. 2016;49:50–3.

    Article  Google Scholar 

  12. Braverman AC. Acute aortic dissection: clinician update. Circulation. 2010;122:184–8.

    Article  Google Scholar 

  13. Katz L, Pitlik S, Porat E, Biderman P, Bishara J. Pericarditis as a presenting sign of infective endocarditis: two case reports and review of the literature. Scand J Infect Dis. 2008;40:785–91.

    Article  Google Scholar 

  14. Nath D, Vaideeswar P, Rojekar A, Vaz W. Spontaneous acute aortic dissection in pregnancy. Am J Forensic Med Pathol. 2013;34:103–6.

    Article  Google Scholar 

  15. Sheikh AS, O’Sullivan M. Pregnancy-related spontaneous coronary artery dissection: two case reports and a comprehensive review of literature. Heart Views. 2012;13:53–65.

    Article  Google Scholar 

  16. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.

    CAS  Article  Google Scholar 

  17. Landenhed M, Engstrom G, Gottsater A, Caulfield MP, Hedblad B, Newton-Cheh C, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc. 2015;4:e001513–3.

  18. Wang Y, Chen S, Wang R, Huang S, Yang M, Liu L, et al. Postmortem diagnosis of Marfan syndrome in a case of sudden death due to aortic rupture: detection of a novel FBN1 frameshift mutation. Forensic Sci Int. 2016;261:e1–4.

    CAS  Article  Google Scholar 

  19. Abad C. Acute infectious mitroaortic endocarditis in association with acute aortic dissection. Surgical management of an unusual combination of diseases. Cardiovasc Surg. 1995;3:605–6.

    CAS  Article  Google Scholar 

  20. Zhang Z, Li Y, Zhao Y. Determinants of disease outcome in patients with drainage of aortic root abscess caused by infective endocarditis. Cell Biochem Biophys. 2015;73:447–50.

    CAS  Article  Google Scholar 

  21. Konishi Y, Tatsuta N, Kumada K, Minami K, Matsuda K, Yamasato A, et al. Dissecting aneurysm during pregnancy and the peurperium. Jpn Circ J. 1980;44:726–33.

    CAS  Article  Google Scholar 

  22. Thalmann M, Sodeck GH, Domanovits H, Grassberger M, Loewe C, Grimm M, et al. Acute type a aortic dissection and pregnancy: a population-based study. Eur J Cardio-Thoracic Surg. 2011;39:e159–63.

    Article  Google Scholar 

  23. Shu C, Fang K, Dardik A, Li X, Li M. Pregnancy-associated type B aortic dissection treated with thoracic endovascular aneurysm repair. Ann Thorac Surg. 2014;97:582–7.

    Article  Google Scholar 

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Correspondence to John Livingstone.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Shattuck, B., Livingstone, J. A case of cardiac tamponade due to an isolated abscess in the ascending aorta of a pregnant woman with a history of intravenous substance abuse. Forensic Sci Med Pathol 13, 226–229 (2017).

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  • Tamponade
  • Isolated
  • Aortic
  • Abscess
  • Pregnant
  • Intravenous