An 80-year-old gentleman was brought into the emergency department with left-sided abdomen pain, low-grade fever of 1-week duration. His past medical history was significant for initial Bentall procedure, bio prosthetic aortic valve replacement, subsequent heart failure with severe bio prosthetic valve failure and stenosis requiring transcatheter aortic valve replacement, post procedure retroperitoneal bleeding requiring blood transfusion and endovascular intervention, subsequent right femoral pseudo aneurysm requiring coiling, abdominal aortic aneurysm post aortic end graft placement and extensive thrombus in abdominal end graft. On physical examination he was afebrile, had a heart rate of 86/min, and had a blood pressure of 106/60 mmHg, he had an ejection systolic murmur in his aortic area and had diffuse tenderness involving his lower abdomen without any guarding and rigidity with normal bowel sounds, and right inguinal swelling without warmth, tenderness and redness. His gram stain was positive for gram-positive cocci in clusters, and culture plate grew raised, white, cohesive, non-hemolytic colonies in blood agar (Figure 1a). His cultures were positive for Staphylococcus epidermidis in all four culture bottles. Computed tomography of his abdomen showed large multifocal splenic infarction and right renal sub segmental infarction (Figure 1b). Multifocal aneurysmal dilatation of the aorta with mural thrombosis involving the descending thoracic aorta was unchanged from his previous study. His electrocardiogram (EKG) showed prolongation of PR (282) and first degree atrioventricular block (AV block) (Figure 1c). His transthoracic echocardiogram was normal but his transesophageal echocardiography revealed the presence of vegetation’s over the prosthetic aortic valve with an abscess cavity, large vegetative mass in the mitral-aortic curtain with clear prolapse of the mass into the LV with to and fro color flow suggesting dehiscence (Figure 1d). He was treated with intravenous vancomycin and meropenem pending culture.

中文翻译：

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主动脉瓣脓肿：表皮葡萄球菌和感染性心内膜炎。

一名80岁的绅士因腹部左侧疼痛，持续1周的低烧而被带入急诊科。他的既往病史对于最初的Bentall手术，生物人工主动脉瓣置换术，随后的心力衰竭以及严重的生物人工瓣膜衰竭和狭窄需要经导管主动脉瓣置换，手术后腹膜后出血需要输血和血管内干预，随后的右股假性动脉瘤具有重要意义需要在主动脉端移植物放置后盘绕，腹主动脉瘤和腹​​端移植物中广泛的血栓。体格检查显示他无发热，心律为86 / min，血压为106/60 mmHg，他的主动脉有收缩期收缩期杂音，下腹部有弥漫性压痛，无任何保护和僵硬，肠鸣音正常，右腹股沟腹胀无温暖，压痛和发红。他的革兰氏染色阳性，呈簇状革兰氏阳性球菌，培养板在血琼脂上生长，呈白色，凝聚性，非溶血性菌落（图1a）。在所有四个培养瓶中，他的培养物均对表皮葡萄球菌呈阳性。他的腹部计算机断层扫描显示大型多灶性脾梗塞和右肾下节段性梗塞（图1b）。主动脉多灶性动脉瘤扩张伴壁血栓形成涉及胸主动脉下降，与他先前的研究相同。他的心电图（EKG）显示PR（282）和一级房室传导阻滞（AV阻滞）延长（图1c）。他的胸腔超声心动图正常，但他的经食道超声心动图检查发现假体主动脉瓣上有赘生物，有脓肿腔，二尖瓣-主动脉幕中有大的营养性肿块，肿块明显向左室脱垂，来回流动色泽提示开裂（图1d）。他接受了静脉万古霉素和美罗培南的治疗，待培养。二尖瓣主动脉幕上有大量的营养物，并且有明显的肿物进入左室，来回流动表明有裂开（图1d）。他接受了静脉万古霉素和美罗培南的治疗，待培养。二尖瓣主动脉幕上有大量的营养物，并且有明显的肿物进入左室，来回流动表明有裂开（图1d）。他接受了静脉万古霉素和美罗培南的治疗，待培养。