Multimodality imaging is crucial for diagnosing rare presentations of infective endocarditis, such as coronary sinus involvement and atrioventricular sulcus abscess causing complete AV block.
A 79-year-old man, who underwent femoropopliteal bypass surgery 1 month prior to admission, presented with fever and fatigue. ECG showed complete atrioventricular block. Transthoracic echocardiography was performed, revealing a round homogeneous right atrial mass and severe mitral regurgitation. Transoesophageal echocardiography revealed involvement the coronary sinus (CS). Computed tomography imaging demonstrated abscess of the atrioventricular sulcus and infiltration of the CS.
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Marschall et al. (2021) studied this question.
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