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Muacevic A, Adler JR. Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management. Cureus 2022; 14:e31010. [PMID: 36349070 PMCID: PMC9632233 DOI: 10.7759/cureus.31010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.
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Mora-Soize C, Carsin-Vu A, Caby GM, Belkessa N, Marcus C, Soize S. Recurrent massive hemoptysis from distal pulmonary pseudoaneurysms complicating invasive aspergillosis in a teenager. Radiol Case Rep 2022; 17:3897-3902. [PMID: 35996719 PMCID: PMC9391511 DOI: 10.1016/j.radcr.2022.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/05/2022] Open
Abstract
Invasive pulmonary aspergillosis in children rarely complicates life-threatening massive hemoptysis. Here, we report the case of a 15-year-old girl with acute lymphoblastic leukemia who was hospitalized for fever and medullary aplasia 1 month after beginning chemotherapy for invasive pulmonary aspergillosis. Despite voriconazole and caspofungine treatment, excavation of some lesions caused a unilateral small pneumothorax and bilateral pleural effusion, justifying intensive care management. The massive hemoptysis that occurred on day 23 was complicated with heart failure, and the patient was promptly resuscitated. Fibroscopy and computed tomography angiography (CTA) did not reveal the origin or cause of the bleeding. A second massive bleeding event occurred on day 32, and heart failure resolved after 10min of low flow. A new CTA showed 2 pseudoaneurysms of the subsegmental pulmonary arteries that were treated with embolization. Sedation was gradually decreased owing to improvement in respiratory status, but the patient did not regain consciousness because of deep brain sequelae. A limitation of care was decided upon, and the patient died in the following weeks. Massive hemoptysis is a rare life-threatening complication of invasive pulmonary aspergillosis, especially in children. Pulmonary artery pseudoaneurysms are unusual and should be detected as soon as possible to guide therapy. Intensive care management should be followed by embolization if the patient is stable; otherwise, surgery is indicated, ideally after identifying the source of bleeding by CTA or bronchoscopy. Early CTA follow-up can be proposed if the source of bleeding is still unknown as pseudoaneurysms can appear or grow rapidly.
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Affiliation(s)
- Caroline Mora-Soize
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
- Department of Diagnostic and Interventional Radiology, Hôpital Robert Debré, CHU de Reims, 51 avenue du Général Koening, Université de Reims Champagne-Ardenne, 51092, Reims, France
- Corresponding author.
| | - Aline Carsin-Vu
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
| | - Gratiela Mac Caby
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
| | - Nasredine Belkessa
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
- Department of Diagnostic and Interventional Radiology, Hôpital Robert Debré, CHU de Reims, 51 avenue du Général Koening, Université de Reims Champagne-Ardenne, 51092, Reims, France
| | - Claude Marcus
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
- Department of Diagnostic and Interventional Radiology, Hôpital Robert Debré, CHU de Reims, 51 avenue du Général Koening, Université de Reims Champagne-Ardenne, 51092, Reims, France
| | - Sebastien Soize
- Department of Radiology, Hôpital Maison Blanche, CHU de Reims, Université de Reims Champagne-Ardenne, 45 rue Cognacq-Jay, 51092, Reims, France
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Aspergillus Mimicking a Rasmussen Aneurysm in an Immunocompromised Setting Causing Massive Hemoptysis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martin BJ, Stephanie H, Muddassir R, Brent MI, Benjamin A, Peter B, Martin G. Successful embolization of an infected aneurysm of a subsegmental pulmonary artery in an infant with necrotizing MRSA pneumonia. Radiol Case Rep 2019; 14:1079-1083. [PMID: 31320966 PMCID: PMC6614110 DOI: 10.1016/j.radcr.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022] Open
Abstract
Para-infections aneurysms are a very rare complication but bear the risk of significant morbidity and mortality in case of rupture and hemorrhage. We present the youngest published case of a right-sided pulmonary artery pseudoaneurysm due to nonmultiresistant Staphylococcus aureus pneumonia in a 7-month old boy, complicated by 2 episodes of significant hemorrhage. Selective microvascular plug embolization of the feeding segmental pulmonary artery by interventional radiology and cardiology was successfully undertaken while having a cardiothoracic surgical team on stand-by. Follow-up ultrasounds showed no residual flow distal to the microvascular plug. The patient had complete clinical recovery 10 months after the initial presentation. Interventional radiology procedures are challenging in children due to limited availability of appropriately-sized equipment, low case numbers, and a limited body of literature.
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Affiliation(s)
- Burren Juerg Martin
- Paediatric Intensive Care Unit, Queensland Children's Hospital, 501 Stanley Street, South Brisbane QLD, Australia
- Child Health Research Centre, Level 6, Centre for Children's Health Research (CCHR), South Brisbane QLD, Australia
- Corresponding author.
| | - Hogarth Stephanie
- Paediatric Intensive Care Unit, Queensland Children's Hospital, 501 Stanley Street, South Brisbane QLD, Australia
| | - Rashid Muddassir
- Paediatric Interventional Radiology Unit, Medical Imaging, Queensland Children's Hospital, South Brisbane QLD, Australia
| | - Masters Ian Brent
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane QLD, Australia
| | - Anderson Benjamin
- Child Health Research Centre, Level 6, Centre for Children's Health Research (CCHR), South Brisbane QLD, Australia
- Queensland Paediatric Cardiology Research Group, Children’s Health Queensland, 501 Stanley Street, South Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Service, Children's Health Queensland, South Brisbane QLD, Australia
| | - Borzi Peter
- Department of Neonatal and Paediatric Surgery, Queensland Children's Hospital, South Brisbane QLD, Australia
| | - Grips Martin
- Queensland Paediatric Cardiology Research Group, Children’s Health Queensland, 501 Stanley Street, South Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Service, Children's Health Queensland, South Brisbane QLD, Australia
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Benhassen LL, Højsgaard A, Allan Terp K, de Paoli FV. Surgical approach to a mycotic aneurysm of the pulmonary artery presenting with hemoptysis - A case report and a review of the literature. Int J Surg Case Rep 2018; 50:92-96. [PMID: 30092541 PMCID: PMC6086216 DOI: 10.1016/j.ijscr.2018.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mycotic aneurysms of the pulmonary arteries are very rare and have high mortality. Risk groups are intravenous drug users and patients with congenital heart disorders. The surgical approach varies due to a limited number of reported cases. PRESENTATION OF CASE We present a case of a mycotic aneurysm of the right pulmonary artery in a 56-year old man presenting with recurrent pneumonias, weight loss and hemoptysis. DISCUSSION There is often a diagnostic delay because of non-specific symptoms mimicking more common disorders. Treatment strategies include conservative management, surgery and endovascular treatment. CONCLUSION This report demonstrates a rare case of aneurysm of the pulmonary artery presenting with hemoptysis. For rapidly progressing proximal aneurysms of the pulmonary arteries, the midline surgical approach is recommended.
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Affiliation(s)
- Leila Louise Benhassen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Anette Højsgaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Kim Allan Terp
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Frank Vincenzo de Paoli
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark; Department of Biomedicine, Aarhus University, Vennelyst Boulevard 4, DK-8000, Aarhus C, Denmark
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Piracha S, Mahmood A, Qayyum N, Ganaie MB. Massive haemoptysis secondary to mycotic pulmonary artery aneurysm in subacute invasive aspergillosis. BMJ Case Rep 2018; 2018:bcr-2017-223088. [PMID: 29674397 DOI: 10.1136/bcr-2017-223088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old man, presented with 3 week history of infective symptoms and mild haemoptysis. Past medical history included severe emphysema and a chronic right upper lobe (RUL) cavity. He was discharged from follow-up a year ago in view of clinical and radiological stability; previous bronchoscopic examinations yielded no specific diagnosis. CT scan on admission confirmed complex cavitary consolidation of RUL. He developed massive haemoptysis requiring intubation and ventilation. CT pulmonary angiogram (CTPA) revealed 16 mm RUL pulmonary artery (PA) aneurysm which was successfully embolized. Sputum cultures, aspergillus antigen and rapidity of clinical progression suggested a diagnosis of subacute invasive aspergillosis (SAIA), prompting treatment with Voriconazole. Bronchoscopy showed blood ooze from RUL even after embolization. Unfortunately, patient continued to deteriorate and succumbed to profound septicaemia.
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Affiliation(s)
- Shahbaz Piracha
- Department of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Asad Mahmood
- Department of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Noman Qayyum
- Department of Radiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Muhammad Badar Ganaie
- Department of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Krishnan AS, Babar JL, Gopalan D. Imaging of congenital and acquired disorders of the pulmonary artery. Curr Probl Diagn Radiol 2012; 41:165-78. [PMID: 22818837 DOI: 10.1067/j.cpradiol.2011.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The pulmonary artery is affected by a multitude of conditions that can be congenital or acquired. These disorders may be detected incidentally, or the clinical features of the different conditions may overlap. This pictorial review illustrates the imaging findings of some of the main conditions that affect the pulmonary artery by considering them in 3 main categories: congenital disorders; enlargement of the pulmonary arteries, most commonly seen in pulmonary hypertension; obstruction or occlusion of the pulmonary arteries, as seen in thromboembolic disease or large vessel vasculitis. It is important for the radiologist to understand the radiological manifestations of these disorders, as early recognition would be of significant benefit in their diagnosis and treatment.
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Affiliation(s)
- Anant S Krishnan
- Department of Radiology, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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Imaging studies for diagnosing invasive fungal pneumonia in immunocompromised patients. Curr Opin Infect Dis 2011; 24:309-14. [PMID: 21673574 DOI: 10.1097/qco.0b013e328348b2e1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim is to review imaging advances in invasive fungal pneumonia in cancer and transplant recipients and how their use can help guide treatment. RECENT FINDINGS Early chest computed tomographic (CT) imaging of immunocompromised patients with neutropenic fever leads to improved survival. Some of the typical CT findings of invasive fungal pneumonia are transitory and are most common during the first week of symptoms. The reversed halo sign, an early sign of disease, is more common in mucormycosis. During the first 10 days of infection, invasive fungal pneumonia nodules may grow on follow-up CT scans, but this does not necessarily equate to worsening disease. Because of the excessive radiation of chest CT and because pulmonary nodule size typically expands during the first few weeks of treatment, follow-up CT scans should be ordered only when therapy changes are dependent on imaging findings. SUMMARY Early chest CT imaging in immunocompromised patients suspected of having invasive fungal pneumonia can help identify disease early, leading to improved outcome.
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Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis 2011; 52:1144-55. [PMID: 21467021 DOI: 10.1093/cid/cir122] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The halo sign is a CT finding of ground-glass opacity surrounding a pulmonary nodule or mass. The reversed halo sign is a focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation. In severely immunocompromised patients, these signs are highly suggestive of early infection by an angioinvasive fungus. The halo sign and reversed halo sign are most commonly associated with invasive pulmonary aspergillosis and pulmonary mucormycosis, respectively. Many other infections and noninfectious conditions, such as neoplastic and inflammatory processes, may also manifest with pulmonary nodules associated with either sign. Although nonspecific, both signs can be useful for preemptive initiation of antifungal therapy in the appropriate clinical setting. This review aims to evaluate the diagnostic value of the halo sign and reversed halo sign in immunocompromised hosts and describes the wide spectrum of diseases associated with them.
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Affiliation(s)
- Sarah P Georgiadou
- Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
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