Intraoperative transoesophageal echocardiographic diagnosis and successful management of mycotic aortitis and pseudoaneurysm.

A 38-year-old intravenous drug using man was scheduled for urgent pericardial window surgery to treat pericardial effusion and tamponade. Transoesophageal echocardiography (TOE) during the procedure revealed a minor residual effusion and an atypical heterogenous thickened appearance of the pericardium and adjoining aortic root. Interrogation of the aortic valve with a 'panning' manoeuvre from the mid-oesophageal aortic valve short axis view showed a small hypoechoic lesion between the right and non-coronary cusp at the level of the sinus of Valsalva. Postoperative high-resolution contrast CT confirmed the anaesthesia TOE findings of a small pseudoaneurysm. The decision was then made to proceed to formal aortic root replacement after 5 days of directed antibiotic therapy and evidence of an increase in aneurysm size to 2.7 cm on repeat CT angiogram. The patient made a good postoperative recovery and was eventually discharged from the hospital 3 weeks after his second operation.