Multimodality imaging in a late septic infection of aortic graft

A 70-year-old diabetic female patient presented with fatigue, headaches, hallucinations and shivers following a history of sinusitis and ophthalmitis. She had an aortic surgery performed 7 years ago for a stenotic and regurgitant aortic valve with aneurysm of the ascending aorta. Work-up brain MRI revealed septic–embolic encephalitis. Multimodality cardiovascular imaging showed abnormal anterior wall of the ascending aortic graft with vegetation extending into the lumen. Blood culture was only positive for Aggregatibacter actinomycetemcomitans, an uncommon cause of infective endocarditis. During aortic surgery, the intraluminal vegetation with suppurated perigraft tissue was confirmed.