case_images: PMC6530244_01
case_images: Chest X-ray on admission (a) compared to the prior chest X-ray (b); black arrows show superior mediastinal fullness compared to the prior study.
case_images: CRIC2019-6915356.001.jpg
case_images: PMC6530244_01_CRIC2019-6915356.001.jpg
case_images: fig1
case_images: A chest X-ray as part of the routine work-up was ordered from the emergency room and showed widening of the superior mediastinum compared to his prior film (Figure 1).
case_images: CT chest with contrast. White arrows show periaortic abscess in the ascending aorta.
case_images: CRIC2019-6915356.002.jpg
case_images: PMC6530244_01_CRIC2019-6915356.002.jpg
case_images: fig2
case_images: Due to this concerning finding, a CT scan of the chest with contrast was ordered and showed a new fluid collection surrounding the ascending aorta and extending into the aortic arch measuring 5 cm in mediolateral dimension at the level of aortic arch (Figure 2).
case_images: Mid-esophageal long-axis view of the heart with Doppler in the transesophageal echocardiogram showing severe aortic regurgitation.
case_images: CRIC2019-6915356.003.jpg
case_images: PMC6530244_01_CRIC2019-6915356.003.jpg
case_images: fig3
case_images: The TEE showed an echolucent area (Figure 3) consistent with fluid or blood around the ascending aorta conduit graft concerning for periconduit leak or abscess.
case_images: Mid-esophageal long-axis view of the heart in the transesophageal echocardiogram. White arrow shows periaortic abscess extending to the root of the aorta.
case_images: CRIC2019-6915356.004.jpg
case_images: PMC6530244_01_CRIC2019-6915356.004.jpg
case_images: fig4
case_images: It also revealed moderate-to-severe aortic regurgitation (Figure 4) with global left ventricular hypokinesis, but no valvular or perivalvular vegetations concerning for endocarditis.