CTICasesProsthetic Aortic Valve Endocarditis with Aortic Root Abscess
Imaging findings
CT angiography in a patient with prior aortic and tricuspid valve replacement and staphylococcal sepsis demonstrates a large, heterogeneous, septated, rim-enhancing collection encircling the aortic root and valve prosthesis, consistent with an aortic root abscess. The right ventricular wall is in close proximity to the abscess, raising concern for imminent fistula formation. The left lung also shows a non-enhancing area of consolidation consistent with septic infarction.
Key takeaways
Aortic root abscess is the most severe complication of prosthetic valve endocarditis, developing when infection extends from the valve annulus into the perivalvular tissues. CT demonstrates a rim-enhancing collection encircling the aortic root, often with extension toward the interventricular septum or right ventricle. Septic emboli to the pulmonary arteries produce septic infarcts visible in the lungs. Surgical mortality is very high, requiring early recognition for planning emergency reoperation.
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