Mycotic pulmonary artery aneurysm secondary to septic emboli

Description

A 16-year-old girl with a medical history of tetralogy of Fallot repaired as an infant with right ventricle (RV) to pulmonary artery (PA) conduit presented to the emergency department with sudden onset fever of 38.4°C, leg cramps and poor oral intake. At admission, she was hypotensive and tachycardic. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus with white blood cell count of 6.1 x10^9/L  and C reactive protein 8.1. An echocardiogram found evidence for moderate conduit stenosis and severe right ventricular hypertrophy, without occlusive vegetation directly visualised. An initial chest CT angiogram (CTA) confirmed these findings, showing an incompletely occlusive vegetation in the RV to PA conduit and multiple peripheral and nodular ground glass opacities, some with cavitation, scattered throughout both lungs consistent with septic emboli (figure 1A). After initiation of anticoagulation and antibiotics, her clinical symptoms steadily improved. Repeat blood cultures remained negative. Follow-up chest...

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