Prompt CT Diagnosis of Epicardial Coronary Abscess after Percutaneous Coronary Intervention Caused by Klebsiella Pneumoniae

Abstract

https://e-kcj.org A 74-year-old female with a history of diabetes and multiple coronary stent insertion [right coronary artery (RCA) and left anterior descending coronary artery] presented to the emergency department (ED) with acute chest pain. Electrocardiogram (ECG) in the ED showed ST elevation in the II, III, and aVF leads as well as increase in the serum troponin T (0.312 ng/mL, normal range 0–0.1 ng/mL), indicating ST-segment elevation myocardial infarction. Occlusion of RCA at its origin was identified on immediate percutaneous coronary intervention (PCI). After balloon dilation of the occluded segment, a pseudoaneurysm was demonstrated at the proximal portion of the RCA, suggesting rupture (Figure 1). PCI was successfully performed although pseudo-aneurysm was developed during the procedure (Figure 1). On hospital day 8, the patient developed a fever (38.5°C). An epicardial coronary abscess with multiple air-pockets and rim-enhancement extending into the right atrioventricular (AV) groove and pericardium was identified on the chest computed tomography (CT) (Figure 2). Klebsiella pneumoniae was identified on blood cultures. Subsequent open heart surgery confirmed the CT findings, and removal of necrotic tissue and abscess with drainage catheter placement was done without extraction of RCA stent. After 6 weeks, the patient was improved and discharged. Korean Circ J. 2021 Mar;51(3):281-282 https://doi.org/10.4070/kcj.2020.0469 pISSN 1738-5520·eISSN 1738-5555