Myocardial abscesses unassociated with infective endocarditis.

Review of 3,084 autopsies from 1967 to 1977 at Grady Memorial Hospital Yielded 14 cases of myocardial abscess unassociated with infective endocarditis acceptable for our study. No case was diagnosed ante mortem. Gram-negative organisms, fungi, and Staphylococcus aureus were isolated. Underlying conditions included alcoholic hepatitis, acute myocardial infarction, systemic lupus erythematosus, and various malignancies. The physical examination, chest roentgenogram, and electrocardiogram were not helpful in establishing a diagnosis. complications included pericarditis and congestive heart failure. A high index of suspicion in a debilitated patient not responding to conventional antimicrobial therapy appears to be the only clue to the antemortem diagnosis. Cardiac scintigraphy is promising as a possible means of earlier detection.