CHEST: A dual lumen Hickman line was inserted via the right internal jugular vein under ultrasound guidance. No immediate complications.
CLINICAL DETAILS: AVR Day 5.
CHEST: There is a right internal jugular line, its tip in the SVC. Mediansternotomy wires and AVR noted. There are small bilateral pleural effusions. Congenital right sided rib anomaly noted.
CLINICAL DETAILS: Post removal of chest drain.
CHEST: Sternal sutures, prosthetic valve and RIJ line are seen. Allowing for the poor inspiration, the lungs appear clear. Minor blunting of the left costophrenic angle is seen consistent with a small pleural effusion. Incidental partial fusion of the posterior aspects of the right fourth and fifth ribs is noted.
CLINICAL DETAILS: Endocarditis. For AVR.
CHEST: The heart is enlarged and has a left ventricular configuration. The lungs are clear. The right 4th and 5th ribs are deformed posteriorly and are fused in places. This does not have the typical appearance of a congenital anomaly and may be related to previous surgery or trauma.
Endocarditis. Recent AVR. Persisting fever. ? infection.
NM WHITECELL SCAN(IN111):
There is prominent focal accumulation of cells in the chest just to the left of the midline and just behind the sternum, a region consistent with the AVR. No other abnormalities can be seen.
COMMENT:
The appearances strongly suggest infection in the region of the aortic value. I think this is more likely to be in the tissue at the level of the aortic root rather than the value itself.
