CTICasesPurulent Myopericarditis with Abscess Formation (Mycotic)
Imaging findings
A neutropenic woman with chest pain developed significant pericardial thickening and inflammation, accompanied by a loculated, rim-enhancing fluid collection in the pericardial space. This collection enlarged rapidly over a few days and appeared to involve or impinge upon the left ventricular wall. A subtle low-attenuation area in the myocardium on a prior study suggested hematogenous seeding of the area, leading to what was considered a purulent myopericarditis with abscess formation.
Key takeaways
Purulent pericarditis, particularly in immunocompromised or neutropenic patients, can manifest as severe pericardial inflammation with loculated fluid collections and discrete abscess formation. Such infection can extend into the myocardium, leading to myopericarditis. Hematogenous seeding can be an initial mechanism for the development of these complex and aggressive infections.
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