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Abscess
Etiology

Bacteria, i.e. staph., strep., pseudomonas, others.
Fungi, i.e. candida, aspergillus, others
Pathogenesis

Infective Endocarditis: Friable vegetations embolize via coronary arteries causing a focal myocarditis, which can progress to abscesses.
Infection of a valve prosthesis along valve ring suture may progress to a valve ring abscess extending into myocardium.
Opportunistic infections in immunocompromised host with septicemia and metastatic abscesses in multiple organs including heart, lung, brain and kidneys.,
Epidemiology

Complicating infective endocarditis, infection of a prosthetic valve, immunosuppresion, or rarely occurring in an otherwise well individual with a secondary pyemia.
General Gross Description

A sharply defined rounded lesion contaning a thick viscid fluid. Often white, but can also be shades of grey and yellow.
Size may vary from microscopic dimensions to visible lesions up to as much as 3 cm in diameter.
Chronic abscesses may have a we1l defined capsule of reactive fibrosis.
•Examples:
Abscess
General Microscopic Description

Neutrophils compose the purulent contents.
Bacteria and/or fungi may be identified with or without the aid of special stains.
•Examples:
Clinical Correlation

Most commonly seen at autopsy as microscopic lesions in immunocompromised cases. Clinical setting is sepsis.
Cases of infective endocarditis may also show microabscesses.
Abscesses complicating infected sutures securing a prosthetic valve are usually grossly obvious. The clinical picture is that of sepsis, and, possibly, a mechanically failing prosthesis with insufficiency of the valve.
References

Cotran RS et.al.: Robbins Pathologic Basis of Disease. 5th edition. Philadelphia, W.B. Saunders, 1994, pp. 550-4
Harrison's Principles of Internal Medicine, 13th Edition: Isselbach et. al. (eds). New York, McGraw-Hill, 1994, pp. 494-8

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Abscess
Synopsis by: J. Hasson, MD (T32000M41740)[328]
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