Use of Multimodality Imaging in Diagnosing Invasive Fungal Diseases of the Heart
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Invasive fungal diseases of the heart are rare, frequently fatal causes of cardiac masses. On imaging, they are difficult to distinguish from other entities, such as thrombi or tumors. The combined use of multiple imaging modalities can aid in diagnosis when integrated with clinical data.1 However, no imaging findings are pathognomonic for invasive fungal disease. We report 4 cases of invasive fungal disease of the heart. Two patients had undergone solid organ transplantation, another had myelodysplastic syndrome, and one was an intravenous drug user. Two patients had invasive aspergillosis, one with valvular endocarditis and another with an intramyocardial abscess, whereas 2 patients had mucormycosis and candidiasis, respectively. Although fungal infections do not have robust central perfusion on cardiac magnetic resonance imaging (a feature of many malignant masses), they often demonstrate delayed peripheral enhancement around the mass, a nonspecific feature suggestive of an infectious cause.2
Case 1: Aspergillus Mitral Valve Endocarditis
A 26-year-old woman with cystic fibrosis, status-post bilateral lung transplantation presented with skin lesions and a positive Galactomannan assay concerning for disseminated aspergillosis. She …