case_images: PMC9390957_01
case_images: A Cut section of the left ventricle of the heart shows a large, mobile vegetations affecting the left coronary cusp of the aortic valve (arrow). The right coronary cusp is slightly affected. B There is a hollow area within the myocardium beneath the vegetations, with an ulcerated opening (arrow). C Cut section of the bulging epicardial surface of the left ventricle revealed large amount of blood clots within the myocardium (arrow). D The pseudoaneurysm contains blood clots and impinges on the coronary artery. The surrounding myocardium is hemorrhagic and soft in consistency, in keeping with acute myocardial infarction (arrows)
case_images: 41935_2022_294_Fig1_HTML.jpg
case_images: PMC9390957_01_41935_2022_294_Fig1_HTML.jpg
case_images: Fig1
case_images: Cut section of the heart revealed large vegetations appearing like irregular nodular lesions affecting the left and right coronary cusps of the aortic valve (Fig. 1a). Further examination of the vegetations at the left coronary cusp revealed a mobile lesion with a necrotic and hollow underneath the area, appearing like a cavity, hidden by the large vegetations (Fig. 1b).
case_images: A and B Section from the cardiac lesion. A Low-power view of the lesion, exhibiting the transmural destruction of the myocardial tissue beneath the valve area (*), replaced by granulating fibrous tissue. There is also a formation of pseudoaneurysm ( ) with extensive hemorrhage ( ) that represents the rupture site. A High-power view shows the fibrin vegetation deposits that are seen at the valve and wall of the pseudoaneurysm, extensively infiltrated by neutrophils
case_images: 41935_2022_294_Fig2_HTML.jpg
case_images: PMC9390957_01_41935_2022_294_Fig2_HTML.jpg
case_images: Fig2
case_images: There fibrin deposits or vegetations are present continuously throughout the internal surface of the pseudoaneurysm lining, which are also mainly infiltrated by neutrophils (Fig. 2).