The diagnosis of myocardial abscess and mural endocarditis is difficult. Blood culture results are positive in 75 percent of patients with myocardial abscess, but this finding is nonspecific. In cases of mural endocarditis, patients frequently have peripheral embolization and splenomegaly, but these findings do not distinguish mural from valvular endocarditis. When these conditions are found at autopsy in a previously undiagnosed patient, endocarditis is frequently the misdiagnosis. Whenever patients present with findings compatible with endocarditis and yet both physical examination and echocardiographic study fail to demonstrate valvular lesions, myocardial abscess and mural endocarditis should be considered. Unfortunately, diagnosis with echocardiography or even cardiac angiography is difficult. Transesophageal echocardiography may offer the best results.
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