Ring Abscess of the Aorta

Ring Abscess of the Aorta

The Common Vein Copyright 2008


Ring Abscess is a suppurative infection of the annulus caused most frequently by infectious endocarditis.

It results in a suppurative accumulation at the base of the aorta.  Such an infection is fatal if left untreated. In many cases, more than one microbial agent is responsible. The most common bacterial agents are E. coli and staphylococci.  With degeneration of the endothelium overlying the annulus, deposition of platelets and fibrin occurs. This fibrous complex is nonbacterial at first, called nonbacterial thrombotic endocarditis. This structural defect can become colonized by bacteria and may progress to a ring abscess that requires drainage. A drained abscess may be complicated by a false aneurysm of a sinus of Valsalva.

A ring abscess is diagnosed by echocardiography.

Surgical treatment involving excision and interposition grafting is a necessary to prevent further spread of infection and damage to the valve.

Ring Abscess of the Aorta

The first gray scale echo of the heart in long axis, shows the left ventricle, anterior and posterior leaflets of the mitral valve, the aortic valve and the base of the aorta. There is a rounded echogenic focus on the aortic valve ring together with a small fluid collection. In the setting of a febrile illness this represents a ring abscess complicating bacterial endocarditis.   The ring abscess is better seen in the second image in transverse projection where two echogenic foci are seen associated with the fluid collection posteriorly.

Courtesy Philips Medical Systems 33133 33168