CTICasesBartonella quintana Endocarditis with Aortic Root Pseudoaneurysm
Imaging findings
CT in a homeless man with a bicuspid aortic valve demonstrates a large pericardial effusion and a contained pseudoaneurysm extending around the aortic root with contrast tracking outside the valve, indicating paravalvular extension of infection.
Key takeaways
Bartonella quintana (agent of trench fever, transmitted by body lice) is a rare but well-recognized cause of culture-negative endocarditis, particularly in homeless, immunocompromised, or socially marginalized individuals. It shares the cat-scratch disease (CSD) organism (Bartonella henselae) niche in the differential. Valve destruction leading to paravalvular pseudoaneurysm is the most feared complication. Diagnosis requires specific Bartonella serologies or PCR of valve tissue, as routine blood cultures are typically negative.
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