Mitral Annular Calcification With <i>Staphylococcus aureus</i> Periannular Abscess
Notice bibliographique
Résumé
A 99-year-old woman presented to the hospital with generalized back pain. The patient's medical history included systemic arterial hypertension and mild chronic renal failure. There was no history of fever or delirium. The patient was afebrile and normotensive with no respiratory distress, and findings on cardiopulmonary examination were unremarkable. Palpation of the abdomen revealed right upper quadrant tenderness without guarding. A complete blood cell count revealed leukocytosis with neutrophilia and a left shift. The patient had evidence of chronic renal failure with a mildly elevated urea. Her serum lactate level was mildly elevated, and she was admitted with a diagnosis of possible bowel ischemia. She was observed for signs of a surgical abdomen and did not receive prophylactic antibiotic therapy. Blood cultures were not performed. Three days after admission, the patient was found unresponsive, and she died shortly thereafter.A complete postmortem examination revealed no bowel ischemia. The heart weighed 400 g, secondary to mild, concentric left ventricular hypertrophy. Changes of mild congestive heart failure were present. Cultures of a 200-mL purulent pericardial effusion grew abundant Staphylococcus aureus.Examination of the cardiac valves revealed severe mitral annular calcification (MAC), indicated by small dark arrows, at the junction of the left ventricle (V) and left atrium (A). The overlying thrombus had eroded and perforated the posterior mitral valve leaflet (white arrows).Microscopy of the MAC revealed amorphous basophilic calcific debris intimately associated with clusters of gram-positive cocci, consistent with Staphylococcus infection. Myocardial and adrenal septic emboli were discovered, along with myocardial, renal, cerebral, and cerebellar microabscesses. Early purulent leptomeningitis was also present. Our patient's cause of death was sepsis, secondary to a S aureus periannular abscess superimposed on MAC.With an aging population, MAC is not an uncommon finding at antemortem imaging or at postmortem examination. MAC is commonly associated with disorders of calcium-phosphate metabolism, including chronic renal failure. MAC is usually solid in consistency; however, liquefactive necrosis can occur; these semisolid masses may penetrate the myocardium and protrude into the left atrial cavity forming a mass.Mitral valves with annular calcification are predisposed to developing both infective endocarditis and periannular abscesses. Although MAC is common, documented sepsis secondary to valvular or perivalvular infection is uncommon and is likely underreported because of difficulties in antemortem diagnosis. With the aging population, MAC may be a more commonly encountered site of infection.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».