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A 9 year old girl with patent ductus arteriosus was referred from a community hospital with a two week history of fever and dyspnoea. Infective endocarditis was diagnosed following positive blood cultures of α streptococcus and two dimensional echocardiographic findings of four vegetations at the bifurcation of the main pulmonary artery. She was treated with intravenous penicillin G 300 000 units/kg daily and gentamicin 5 mg/kg daily. On the 30th day of admission, she developed massive haemoptysis with cardiovascular collapse and was resuscitated with intravenous fluid and blood transfusion. She had five more episodes of haemoptysis during admission. Penicillin G was given for eight weeks and gentamicin for two weeks. The patient was provisionally diagnosed with mycotic aneurysms of the pulmonary arteries, and cardiac catheterisation was performed after a complete course of antibiotics. Patent ductus arteriosus was demonstrated by aortogram. The pulmonary to systemic blood flow ratio was 2.5 to 1. Selective pulmonary angiograms showed mycotic aneurysms—a complication of infective endocarditis—in the left lower and right middle pulmonary arteries (panels A and B).
The patient underwent division and suture of the patent ductus arteriosus and subsequently progressed well. A second cardiac catheterisation was performed 14 months after surgery, and angiograms revealed regression of the mycotic aneurysms in the pulmonary arteries (panels C and D).
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