CTICasesSeptic Pulmonary Embolism and Intracardiac Vegetation from Factitious Fecal Injection
Imaging findings
Chest CT demonstrates a large, mobile vegetation or infected thrombus in the right ventricle and atrium containing multiple internal foci of gas. A pulmonary artery embolus is also present and similarly contains internal gas bubbles, indicating a septic thrombus with gas-producing organisms. Cardiac MRI utilizes magnitude-reconstruction images at varying inversion times (TI) to evaluate the mass, showing characteristic nulling behavior at longer inversion times (TI of 600 ms) and a complete lack of enhancement, confirming the diagnosis of thrombus rather than a primary cardiac tumor.
Key takeaways
The presence of gas bubbles within an intracardiac vegetation or pulmonary embolus is an alarming finding that typically indicates infection by gas-forming organisms. In this case, the findings were a direct consequence of factitious illness (Munchausen syndrome) where the patient deliberately self-injected fecal material through a central venous catheter. Cardiac MRI serves as an excellent tool to differentiate avascular thrombus or vegetation from hypervascular cardiac tumors by demonstrating a lack of tissue enhancement and characteristic nulling behavior at long inversion times.
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