SHM Converge Scientific Abstract ePoster Gallery-Occult Coronary Arteriovenous Fistula Uncovered During Evaluation of Streptococcus Gordonii Bacteremia and Possible Endocarditis

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This case report describes a 59-year-old woman who presented with appetite loss, weight loss, and night sweats after a recent tooth extraction for a periapical abscess. She was afebrile but had leukocytosis and elevated CRP. Chest CT showed multiple small cavitating nodules in both lower lungs, suspicious for septic pulmonary emboli. Blood cultures grew Streptococcus gordonii, raising strong concern for infective endocarditis (IE).<br /><br />Although transthoracic and transesophageal echocardiography showed no valvular vegetations, they revealed bilateral coronary ostial dilation and an abnormal vessel along the left atrial wall. Because IE remained suspected, further coronary imaging was performed. Coronary CT angiography and invasive angiography identified an occult coronary arteriovenous fistula (CAF) arising from both the right coronary artery and left circumflex artery, draining into the coronary sinus.<br /><br />The patient improved rapidly with intravenous ceftriaxone. She was later switched to oral amoxicillin-clavulanate, but this was stopped after a severe drug eruption. She had no recurrence of fever during follow-up. Surgical closure of the CAF is being considered by a multidisciplinary team.<br /><br />The authors emphasize that negative echocardiography does not exclude IE, especially when embolic phenomena and positive blood cultures are present. In this case, the patient met criteria for possible IE under the 2023 ESC Guidelines. They also highlight that CAF, though rare and often asymptomatic, can be an underlying cause of right-sided IE and septic emboli. When echocardiography is nondiagnostic, clinicians should consider structural abnormalities such as CAF and pursue advanced cardiac imaging when appropriate.

Asset Subtitle

Yusuke Miyazato

Meta Tag

Author List Mai Uchida, Ryosuke Horitani, Shintaro Kuki, Yusuke Miyazato

Category Clinical Vignettes

Concept Infective Endocarditis

Concept Coronary Arteriovenous Fistula

Concept Right-sided Infective Endocarditis

Concept Septic Pulmonary Emboli

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization Hashimoto Municipal Hospital

Presenting Author Yusuke Miyazato

Track Adult

Keywords

infective endocarditis

Streptococcus gordonii

septic pulmonary emboli

coronary arteriovenous fistula

coronary sinus

coronary CT angiography

echocardiography

blood cultures

tooth extraction

cavitating nodules

Infective Endocarditis

Coronary Arteriovenous Fistula

Right-sided Infective Endocarditis

Septic Pulmonary Emboli

Echocardiography