Rare Coexistence of Abdominal Aortic Aneurysm and Pericardial Effusion: A Case Report.

Abstract

We report the case of a 59-year-old male who presented to the emergency department with a two-week history of progressive shortness of breath, intermittent fever, fatigue, and reduced exercise tolerance. He later developed non exertional central chest discomfort, vague abdominal pain, and poor appetite with unintentional weight loss. There was no history of recent invasive procedures or known cardiac disease. On presentation, he was febrile, tachycardic, and mildly hypoxemic, with elevated jugular venous pressure, bilateral basal crackles, and a subtle early diastolic cardiac sound. Abdominal examination revealed a suspected pulsatile mass. Initial investigations showed raised inflammatory markers and leukocytosis. Chest radiography demonstrated cardiomegaly, while bedside ultrasound revealed a moderate pericardial effusion and a fusiform infrarenal abdominal aortic dilatation. Computed tomography of the abdomen confirmed an abdominal aortic aneurysm with features suggestive of infective involvement. Blood cultures later grew a streptococcal species consistent with infective endocarditis. The patient was managed with targeted intravenous antibiotics after initial empirical therapy, along with close hemodynamic monitoring. Cardiology input supported conservative management of the pericardial effusion as there were no signs of tamponade. Vascular surgery recommended initial non operative management of the suspected mycotic aneurysm with strict blood pressure control and prolonged antibiotic therapy. Multidisciplinary care was central to management, including infectious diseases, cardiology, and vascular surgery teams. This case highlights an unusual presentation of infective endocarditis complicated by both pericardial effusion and abdominal aortic aneurysm, emphasizing the importance of early imaging, blood culture diagnosis, and multidisciplinary coordination in detecting and managing systemic infectious vascular complications.