Myocardial abscess, a rare form of cardiac aspergillosis.

MOTS CLÉS Abcès myocardique ; Aspergillose ; Aspergillus fumigates A 63-year-old woman with aplastic anaemia was admitted to hospital for fever and malaise. Computed tomography (CT) scan showed a cavitary nodular lesion in the left lower lobe, which was highly suspicious for pulmonary aspergilloma (Fig. 1A-1). A semilunar shaped, low-density lesion within the left ventricular free wall accompanied by mild pericardial effusion was found on the CT scan and magnetic resonance image (Fig. 1A-2 and B). Transthoracic echocardiography showed an echo-free lesion within the left ventricular anterolateral wall (Fig. 1C). A serological study confirmed the presence of the specific antigen of Aspergillus fumigates in the blood, and antifungal treatment was started. Two weeks later, the echolucent space did not show any changes on follow-up echocardiogram, so surgery was performed. After starting standard cardiopulmonary bypass, needle aspiration of the swelling on the left ventricle confirmed the presence of pus (Fig. 2A). The abscess pocket was incised, debrided, irrigated, and obliterated with an autologous pericardial strip (Fig. 2B). A cavitary mass in the left lower lobe was resected. Microscopic examination did not reveal any evidence of microorganisms in the abscess fluid; however, Aspergillus was detected on the pathological report of the resected pulmonary lesion. The patient was discharged without complication after completing 4 weeks of antifungal therapy. Follow-up CT scan did not show any evidence of low-density lesion in the ventricle, and the patient remains free of symptoms 1 year later (Fig. 1D).