A chest wall pulsating mass

A 34-year-old HIV-positive man with intravenous drug addiction presented with a 2-week history of fever and a pulsatile presternal mass; 2 weeks prior he had suffered a traumatic sternal fracture. The CT scan showed a bulky abscess with presternal and retrosternal extension that contacted the heart...

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Bibliographic Details
Published in:BMJ case reports 2015-04, Vol.2015, p.bcr2014207972
Main Authors: Patrício, Catarina, Ribeiro, Rita, Malheiro, Rui, Silva, Filipa Pais da
Format: Article
Language:English
Subjects:
Abscesses
Adult
Anti-Bacterial Agents - therapeutic use
Antibiotics
Drug therapy
Echocardiography, Transesophageal
Endocarditis
Endocarditis, Bacterial - diagnosis
Endocarditis, Bacterial - drug therapy
Europe (West)
Fractures
Fractures, Bone - complications
Heart
HIV
HIV Seropositivity - complications
Human immunodeficiency virus
Humans
Infections
Male
Medical imaging
Patients
Reminder of Important Clinical Lesson
Staphylococcal Infections - diagnosis
Staphylococcal Infections - drug therapy
Sternum - injuries
Substance Abuse, Intravenous - complications
Thoracic Wall - pathology
Tuberculosis
White
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Summary:A 34-year-old HIV-positive man with intravenous drug addiction presented with a 2-week history of fever and a pulsatile presternal mass; 2 weeks prior he had suffered a traumatic sternal fracture. The CT scan showed a bulky abscess with presternal and retrosternal extension that contacted the heart (which explained its pulsatile effect) and pulmonary necrotising lesions. Drainage of the thoracic wall abscess was performed, and antibiotics (flucloxacillin plus gentamicin) were started on the presumption of staphylococcal bacteraemia given the patient's intravenous drug habit. Blood cultures and culture of the aspirated pus confirmed growth of methicillin-sensitive Staphylococcus aureus; transoesophageal echocardiography showed endocarditis of the tricuspid valve. We therefore assumed pulmonary septic embolisation from right-sided endocarditis and acute sternal osteomyelitis, and the patient was treated for 6 weeks with clinical resolution.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-207972