Pathology cases — bacterial endocarditis

This is a repost from the now-defunct Pretty Pics series, with a couple of additions.  I don’t remember the actual case any more, but the typical story is that of a young adult intravenous drug abuser with sepsis or some catastrophic failure (stroke, sudden arrhythmia, etc).  At autopsy, there is a vegetation (or multiple vegetations) with microabscesses downstream.  If the vegetation is on the right, then there’s typically a pneumonia, and if it’s on the left then multiple organs are seeded.  In this case, there were microabscesses in multiple organs.

Grossly, these things look like they sound — sort of amorphous globs on a valve, with some adherent clot.  I guess I’ve had about 30 or so of these cases in the past five years.  Usually they aren’t all that big when I see them.  Here are a couple of gross dissection pics of a couple of ones I’ve seen:

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Though they can get pretty large.  This one sat over a mechanical valve replacement from a previous vegetation:

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Here’s a typical microscopic appearance of layers of fibrin, inflammatory cells and bacteria:

 

 

In this case that I made photomics for, there were abscesses in multiple organs, including the heart:

The liver:

The spleen:

The kidney:

And the brain:

As always, free for use in lecture, or teaching, with or without attribution (though attribution is appreciated).  If you put these in a publication, please contact me.  Higher resolution images with lossless compression are available on request until I lose them, if you need them for a lecture or such.  Email me if you want me to send them to you.

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