Cardiology and Medical Interventions

The hidden cardiovascular disease at a patient with pain in the left hypochondrium

 

Objective: The most important objective of this presentation is to found the real cause of a patient with came at the consultation

with sudden pain in the left hypochondrium.

Method: Present the clinical case of a young patient 29 years old, which came at the consultation for sudden onset of pain in the

left hypochondrium, chills and fever 40ºC. At the objective examination BP=120/80 mmHg, HR=100 beats/minute, rhythmic

heart sounds, normal intensity and a systolic murmur heart on the middle of chest, degree III, without irradiation. Auscultation

of the lung was normal vesicular sound. At palpation of the abdomen presented sensibility in the left hypochondrium. The

laboratory tests showed: ESR=60/80 mmHg, fibrinogen=600 mg/dl, leukocytes=16000/mm3, urine examination normal, the

blood culture Staphylococcus aureus positive. The abdominal ultrasound put in evidence unexpected, many small nodules

inside of the parenchyma of the spleen as small cysts and in rest normal. The echocardiography of the heart put in evidence

unexpected an atrial septum defect medium and vegetation of this level. The patient follows antibiotic therapy I.V. and was

referred to as the cardiovascular surgery department.

Result: This patient was in reality with a bacterial endocarditis on an unknown congenital heart disease-atria septum defect and

the small nodules inside of the spleen were microemboli septic in the context of bacterial endocarditis.

Conclusion: This case is interesting because the real cause of the patient with pain in left hypochondrium represented in fact

microemboli in the spleen in the context of endocarditis at a patient with unknown congenital heart disease.