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Sakakibara S, Yamauchi T. Mycotic superior mesenteric artery aneurysm with impending rupture due to infective endocarditis. J Vasc Surg Cases Innov Tech 2024; 10:101600. [PMID: 39314856 PMCID: PMC11417310 DOI: 10.1016/j.jvscit.2024.101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/26/2024] [Indexed: 09/25/2024] Open
Abstract
A 49-year-old woman with tachycardia was referred to our institution. Transthoracic echocardiography revealed severe mitral regurgitation, and surgery was planned. While awaiting surgery, she developed a fever. Transthoracic echocardiography and transesophageal echocardiography revealed vegetation on the mitral valve leaflet. Blood cultures were positive for Streptococcus anginosus. She was diagnosed with infective endocarditis, and antibiotics were administered. She experienced sudden abdominal pain 26 days after hospitalization. Contrast-enhanced computed tomography scan revealed a mycotic superior mesenteric artery aneurysm with impending rupture without intestinal ischemia, and aneurysm resection was performed. Mitral valve replacement was performed on postoperative day 10, with uneventful postoperative healing.
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Affiliation(s)
- Satoshi Sakakibara
- Department of Cardiovascular Surgery, Higashiosaka City Medical Center, Osaka, Japan
| | - Takashi Yamauchi
- Department of Cardiovascular Surgery, Higashiosaka City Medical Center, Osaka, Japan
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2
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Ravindra A, Naguthevar S, Kumar D, Rajagopal R, Khera PS, Tak V, Ramankutty NT, Meena DS, Midha N, Bohra GK, Garg MK. Mycotic aneurysms: uncommon pathogens and treatment conundrums. Access Microbiol 2024; 6:000777.v5. [PMID: 39165253 PMCID: PMC11334579 DOI: 10.1099/acmi.0.000777.v5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction. Mycotic aneurysms, characterized by vessel wall dilation resulting from infections including bacteria, fungi, and viruses, are a rare but severe consequence of systemic infections. The term 'mycotic' was coined by William Osler to describe the first instance of a fungal-induced infected aneurysm. These aneurysms, accounting for 0.6% of aneurysms in Western countries, carry a higher risk of rupture compared to uninfected aneurysms. While the femoral artery, aorta, and intracranial arteries are commonly affected, pathogens causing mycotic aneurysms vary across regions. Diagnostic challenges arise from nonspecific symptoms such as fever, and discomfort. To prevent the substantial morbidity and mortality associated with mycotic aneurysms, timely identification and treatment are paramount. We present a case series highlighting mycotic aneurysms caused by some rare pathogens - Salmonella Paratyphi A, Streptococcus pneumoniae, and Pseudomonas aeruginosa. Methods. This case series involves three patients diagnosed with mycotic aneurysms due to unusual pathogens. We describe each patient's clinical presentation, medical history, physical examination findings, laboratory results, imaging studies, and the diagnostic process leading to the identification of the causative pathogens. Results. The first patient is a 70-year-old gentleman who presented with a ruptured infra-renal abdominal aortic pseudoaneurysm caused by Salmonella Paratyphi A. The second patient is a 66-year-old gentleman with a Streptococcus pneumoniae-associated descending thoracic aortic pseudoaneurysm. The third patient is a 70-year-old gentleman with a ruptured descending thoracic aortic aneurysm with an occult aorto-oesophageal fistula due to Pseudomonas aeruginosa infection. The description highlights unique clinical features, laboratory findings, imaging results, and the management approaches undertaken in each patient. Conclusion. Mycotic aneurysms, pose diagnostic challenges due to their nonspecific symptoms. Early identification and intervention are essential to mitigate the severe complications associated with these aneurysms. The presented cases underscore the need for a comprehensive approach to diagnosis and management, ensuring optimal outcomes for patients affected by mycotic aneurysms.
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Affiliation(s)
- Akshatha Ravindra
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Santhanam Naguthevar
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rengarajan Rajagopal
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neetha Thayil Ramankutty
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Durga Shankar Meena
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naresh Midha
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gopal Krishana Bohra
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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3
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Atassi ASS, Vilanilam GK, Purushothaman R, Zemianschi R, Pandey I, Messer KJ, Vattoth S. Lumbar vertebral diskitis-osteomyelitis with mycotic abdominal aortic aneurysm caused by Streptococcus mitis. Radiol Case Rep 2024; 19:2719-2723. [PMID: 38680736 PMCID: PMC11046692 DOI: 10.1016/j.radcr.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/12/2024] [Indexed: 05/01/2024] Open
Abstract
Vertebral osteomyelitis is a well-documented disease entity in literature with various known etiologies. However, vertebral diskitis-osteomyelitis secondary to an infected aortic aneurysm is an uncommon and life-threatening complication. We present the case of a 65-year-old male patient who presented with chronic low back pain that acutely worsened for 1 to 1.5 months and was diagnosed with vertebral diskitis-osteomyelitis secondary to a contiguous infection from an adjacent mycotic aortic aneurysm. To our knowledge, this is one of the few cases reported of vertebral diskitis-osteomyelitis secondary to mycotic aortic aneurysm. We discuss the findings on CT and MRI, as well as the value of imaging in guiding management.
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Affiliation(s)
| | - George K. Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Rangarajan Purushothaman
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Razvan Zemianschi
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Ishan Pandey
- Baylor Hankamer School of Business, Baylor University, Waco, TX 76706, USA
| | - Kurt J. Messer
- Division of Body Imaging, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Surjith Vattoth
- Diagnostic Radiology & Nuclear Medicine, Division of Neuroradiology, Rush University Medical Center, Chicago, IL 60612, USA
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Muthu V, Agarwal R. Pulmonary Artery Aneurysms: Mycotic or Mycobacterial? Clin Infect Dis 2024; 78:805-806. [PMID: 37721129 DOI: 10.1093/cid/ciad554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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5
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Provost H, Drudi LM, Schwenter F, Elkouri S, Blair JF, Charbonneau P. A mycotic aneurysm of a jejunal branch treated by aneurysmectomy without bowel resection. J Vasc Surg Cases Innov Tech 2024; 10:101364. [PMID: 38130368 PMCID: PMC10731609 DOI: 10.1016/j.jvscit.2023.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/21/2023] [Indexed: 12/23/2023] Open
Abstract
Jejunal artery pseudoaneurysms are extremely rare, accounting for <1% of all visceral artery pseudoaneurysms. Fewer than 50 cases were reported in literature during the previous century. This case report describes the case of a 72-year-old man who underwent aneurysmectomy to treat a 21-mm mycotic jejunal artery pseudoaneurysm found in the setting of endocarditis. This pseudoaneurysm was treated with laparotomy, and gentle dissection of the tissues surrounding the pseudoaneurysm was performed before ligation and resection. This allowed for vascular collateral branch preservation, which, thus, avoided concomitant bowel resection. This report highlights the feasibility of this technique.
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Affiliation(s)
- Hubert Provost
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Laura M. Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Frank Schwenter
- Department of General Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Stéphane Elkouri
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Aortic Centre, Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Jean-François Blair
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Aortic Centre, Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Philippe Charbonneau
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Aortic Centre, Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
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Vulasala SS, Singareddy A, Dasari SM, Wallack M, Gopireddy D. Ruptured Mycotic Aneurysm of the Superior Mesenteric Artery: A Case Report. Cureus 2024; 16:e54004. [PMID: 38476804 PMCID: PMC10928462 DOI: 10.7759/cureus.54004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/11/2024] [Indexed: 03/14/2024] Open
Abstract
An infected (mycotic) aneurysm of the visceral arteries is an uncommon entity, which may arise from a secondary infection of a preexisting aneurysm or be due to degeneration from a primary infection. Mycotic aneurysms require prompt recognition and definitive treatment; otherwise, there can be devastating morbidity and mortality. We present the case of a 51-year-old female with HIV and Crohn's disease who presented with subacute abdominal pain, nausea, and vomiting and was found to have an ultimately fatal mycotic aneurysm of the superior mesenteric artery. In addition, we discuss the characteristic imaging features of mycotic aneurysms on computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Sai Swarupa Vulasala
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Anastasia Singareddy
- Skin Biology and Dermatological Sciences, University of Miami Miller School of Medicine, Miami, USA
| | | | - Max Wallack
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Dheeraj Gopireddy
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Hali R, Sharifkazemi M, Yaminisharif A, Bagheri J, Shahbazi N. Coronary artery mycotic aneurysm in a patient suffering from subacute endocarditis: a case report and literature review. Front Cardiovasc Med 2023; 10:1188946. [PMID: 37600033 PMCID: PMC10435280 DOI: 10.3389/fcvm.2023.1188946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Although mycotic aneurysm is a known and important disease in the cerebrovascular system, especially the brain, there are scarce reports about coronary artery mycotic aneurysms (CAMA). CAMA can occur not only in the context of endocarditis but also as a rare adverse event of coronary artery stenting, which has been used more extensively in recent years. Accordingly, it is essential to pay greater attention to its associated presentations and clinical course. Considering the scant evidence available, reporting the disease course of each patient with CAMA can help increase the physician's knowledge about this condition, which is why we are reporting this case. A 42-year-old man with diabetes was referred to our center with embolic left cerebellar infarction 3 months earlier, as well as a 2-month history of feverishness before his referral. His blood culture was positive for Viridans Streptococci, and he had paraclinical signs of inflammation and two- and three-dimensional transthoracic and transesophageal echocardiography (2D & 3D TTE and TEE) signs of aortic and mitral valves' infective endocarditis with the destruction of the aortic valve, severe aortic and mitral regurgitation, severe pulmonary hypertension, and moderate biventricular systolic dysfunction. Regarding the obviously dilated left main coronary artery on TEE images, contrast-enhanced chest multidetector computed tomography was performed for better assessment of coronary arteries with suspicion of CAMA, which confirmed aneurysmal dilatation of the proximal left main coronary artery. The presence of bacteria was confirmed on staining the valvular tissue, resected during the surgical replacement of aortic and mitral valves. As the cardiac surgeon considered CAMA resection and coronary bypass grafting high risk for the patient, he received parenteral antibiotic therapy, for 6 weeks. At 1-year follow-up, he was doing well with no signs/symptoms of endocarditis and well-functioning mechanical prosthetic valves. This case shows the significance of considering CAMA in the setting of endocarditis, resistant to medical and/or surgical therapy or in patients with coronary aneurysm, simultaneous with active endocarditis. Therefore, more attention should be paid to this extravalvular complication of endocarditis, and its possibility should be considered and investigated in any patient presented with valvular endocarditis, especially involving the aortic valve.
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Affiliation(s)
- Reza Hali
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Yaminisharif
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Cardiovascular Surgery Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Shahbazi
- Pathology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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8
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Shahid M, Phan B, Tir V, Engel C, El-Bahri J. Mycotic Aneurysm of the Thoracoabdominal Aorta: A Diagnostic Challenge. Cureus 2023; 15:e40894. [PMID: 37492842 PMCID: PMC10365147 DOI: 10.7759/cureus.40894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Mycotic aortic aneurysms (MAAs) are a rare form of aortic aneurysms that are associated with catastrophic outcomes if not diagnosed and treated on time. However, MAAs are a diagnostic challenge owing to their often nonspecific presentation. In this study, we present a case of a 42-year-old female with a pertinent history of intravenous drug use who presented with generalized body pain for two weeks and was found to have a mycotic thoracoabdominal aortic aneurysm (TAAA) extensively involving adjacent structures, including lungs with pleural cavity and upper renal pole. Not only does this case highlight the difficulty in early diagnosis and complex pathology of a mycotic TAAA, but it also illustrates the multidisciplinary approach required to effectively treat them.
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Affiliation(s)
- Maham Shahid
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Benjamin Phan
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Vincent Tir
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Corey Engel
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Jessica El-Bahri
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
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9
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Faruk M, Satria B, Alwi A, Cahyaningtyas C. A rare case of femoral artery saccular aneurysm caused by tuberculosis in a male patient: A case report and review of literature. Int J Surg Case Rep 2023; 106:108143. [PMID: 37062194 PMCID: PMC10139898 DOI: 10.1016/j.ijscr.2023.108143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is still a major global health issue. In over 75 % of all cases of mycotic aneurysm, TB spreads directly by eroding through the vascular wall. Aortic and innominate arteries are frequently the sites of tubercular aneurysms, primarily due to contiguous dissemination from pulmonary infection sites. We report a case of a saccular aneurysm at the distal common femoral artery associated with tuberculosis. CASE PRESENTATION A 34-year-old man had the chief complaint of a voluminous pulsatile mass in the left thigh. We found a bruit on auscultation examination at the site of the mass. A computed tomography (CT) angiography showed a saccular aneurysm at the distal common femoral artery and stenosis at the proximal femoral profunda artery. A chest CT scan was conducted, and the result showed a ground-glass appearance and multiple enlarged lymph nodes. CLINICAL DISCUSSION The patient was treated surgically by resection of the aneurysm and reconstruction with an inter-positional saphenous vein graft. Later, he was treated with a drug regimen for tuberculosis by pulmonologist. The patient was discharged with no post-operative complications. CONCLUSION Patients with femoral artery aneurysms are at high risk of rupture and death by exsanguination. It can be a severe complication of tuberculosis, especially in immunocompromised patients. Although this was a very rare case, all surgeons must be aware. A combination of medical and surgical intervention is imperative. Careful clinical care postoperatively is mandatory because of the risk of repetitive anastomotic aneurysms and recurrent aneurysms in another vessel.
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Affiliation(s)
- Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Bayu Satria
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ahmadi Alwi
- Department of Surgery, Tadjuddin Chalid Hospital, Makassar, Indonesia
| | - Cheria Cahyaningtyas
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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10
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Kumar MB, Varada L, Abuji K, Savlania A, Ray P, Angrup A. Mycotic aneurysm by Bacteroides fragilis presenting as fever of unknown origin. Indian J Med Microbiol 2023; 41:53-54. [PMID: 36870751 DOI: 10.1016/j.ijmmb.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/08/2023]
Abstract
A mycotic aneurysm is an infection of the vessel wall which can be bacterial, fungal, or viral in origin. It is invariably a fatal infectious disease if appropriate treatment is not done. We describe the case of a forty-six years male who presented with complaints of high-grade fever and lower back pain with worsening symptoms with the passage of the illness. An infrarenal lobulated abdominal aortic aneurysm was confirmed by CT angiography. He underwent aneurysmorrhaphy and metronidazole was started following the culture report (Bacteroides fragilis). He was discharged successfully from the hospital.
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Affiliation(s)
- Mani Bhushan Kumar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lokesh Varada
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kishore Abuji
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Savlania
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Ameri M, Gonzalez-fraga J, Orndorff J, Ecker AE, Cherner A, Patel KP. Mycotic Pseudoaneurysm: Clinical Course, Management and Prognosis. Cureus 2022; 14:e28408. [PMID: 36072172 PMCID: PMC9440977 DOI: 10.7759/cureus.28408] [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] [Accepted: 08/25/2022] [Indexed: 12/01/2022] Open
Abstract
Pseudoaneurysm of vessels (most common in arteries), in general, happens when a blood vessel wall is damaged leading to leakage of blood and its collection in the surrounding tissue, essentially resulting in a false aneurysm. These false collections can be problematic and can develop in any location. However, their most common clinical presentation is in the femoral arteries. These manifest especially following an endovascular intervention. Here, we discuss a case of a 73-year-old male whose in-hospital course was complicated by the development and subsequent infection of a pseudoaneurysm after he was admitted for sepsis from a UTI. We further highlight the pathophysiology related to the formation of a pseudoaneurysm, and the mechanism of action behind various treatment modalities used. The clinical course and possible treatment options may vary. However, a robust combination of early surgical management alongside medical management seems to provide the best outcome.
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12
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Iro MA, Jones CE, Faust SN, Wilson IDC, Baxter SJ, Pemberton M, Richens T, Patel SV. Mycotic aneurysm presenting as hip pain and severe anaemia. Arch Dis Child 2021; 106:1211. [PMID: 33853765 DOI: 10.1136/archdischild-2021-321632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Mildred A Iro
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK .,Paediatric Immunology and Infectious diseases, Southampton University NHS Foundation Trust, Southampton, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, Southampton University NHS Foundation Trust, Southampton, Southampton, UK
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.,Paediatric Immunology and Infectious diseases, Southampton University NHS Foundation Trust, Southampton, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, Southampton University NHS Foundation Trust, Southampton, Southampton, UK
| | - Saul N Faust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.,Paediatric Immunology and Infectious diseases, Southampton University NHS Foundation Trust, Southampton, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, Southampton University NHS Foundation Trust, Southampton, Southampton, UK
| | - Iain D C Wilson
- Radiology, Southampton University NHS Foundation Trust, Southampton, Southampton, UK
| | - Stephen J Baxter
- Cardiovascular and Thoracic Surgery, Southampton University NHS Foundation Trust, Southampton, Southampton, UK
| | - Mark Pemberton
- Cardiovascular and Thoracic Surgery, Southampton University NHS Foundation Trust, Southampton, Southampton, UK
| | - Trevor Richens
- Paediatric Cardiology, Southampton University NHS Foundation Trust, Southampton, Southampton, UK
| | - Sanjay Valabh Patel
- Paediatric Immunology and Infectious diseases, Southampton University NHS Foundation Trust, Southampton, UK
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13
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Alquichire-Luna CA, García-Bohórquez DF, Hernández-Vargas JC, García-Bohórquez JA, Fajardo-Rivero JE. Mycotic Pulmonary Aneurysm Managed With Covered Stent. Vasc Endovascular Surg 2021; 56:117-120. [PMID: 34625008 DOI: 10.1177/15385744211042179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mycotic aneurysms are vascular dilations caused by fungal or bacterial infections. The involvement of the pulmonary artery or its branches is extremely rare with only a few cases reported in the literature posing a diagnostic challenge. We present the case of a young adult patient with acute myeloid leukemia undergoing chemotherapy, who presented with febrile neutropenia, recurrent bacteremia due to Pseudomona Aeruginosa and Klebsiella Pneumonie and hemoptysis. The management was unconventional, opting for the placement of a covered endovascular stent, being the first successful case with this reported technique. Rapid detection of this pathology and individualization in the management of each patient is essential because of high risk of mortality due to sepsis and rupture of the aneurysm.
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14
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Campos R, Yung G, Russo R, Mansberg R. Dissecting Mycotic RCA Aneurysm Detected on 67Ga Scintigraphy. Clin Nucl Med 2021; 46:822-825. [PMID: 34477602 DOI: 10.1097/rlu.0000000000003677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 61-year-old man presented with pneumonia and myocardial infarction on a background of diabetes and end-stage renal failure. Methicillin-resistant Staphylococcus aureus bacteremia was confirmed in the setting of ongoing pyrexia. The patient was referred for a 67Ga study, which revealed Ga-avid active disease in the pericardial effusion. This was localized further on CT/MRI and coronary angiography to a dissecting right coronary artery aneurysm, which was treated with surgical repair and long-term antibiotic treatment.
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Affiliation(s)
- Rossana Campos
- From the Department of Nuclear Medicine, Concord Hospital, Concord
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15
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Khan F, Sharma N, Ud Din M, Shirke S, Abbas S. Convexal Subarachnoid Hemorrhage Caused by Infective Endocarditis in a Patient with Advanced Human Immunodeficiency Virus (HIV): The Culprits and Bystanders. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931376. [PMID: 33986239 PMCID: PMC8130978 DOI: 10.12659/ajcr.931376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Convexal subarachnoid hemorrhage (cSAH), a rare form of non-aneurysmal subarachnoid hemorrhage, is confined to cerebral convexities without extension into basal cisterns or ventricles. Typical presentation includes thunderclap/progressive headache or transient focal neurological symptoms; rare manifestations include seizures, intractable vomiting, or altered mental status. Here, we report the first case of convexal subarachnoid hemorrhage and multifocal ischemic lesions caused by infective endocarditis (IE) in a treatment-naïve advanced HIV patient. CASE REPORT A 52-year-old HAART-naïve, HIV-positive, African American man presented with altered mental status, shortness of breath, nonproductive cough, and generalized weakness. His past medical history was significant for congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (noncompliant with hemodialysis). Head computed tomography (CT) showed an isolated sulcal hemorrhage in the mid-left frontal lobe. Fluid-attenuated inversion recovery/gradient recalled echo sequences confirmed a hemorrhage in the left-mid-frontal sulcus, and diffusion-weighted imaging revealed multifocal bilateral ischemic lesions. Transesophageal echocardiography exhibited mitral valve vegetations. Multifocal ischemic lesions and cSAH caused by infectious endocarditis were confirmed. Initiation of intravenous vancomycin and piperacillin-tazobactam allowed the patient to have resolution of his altered mental status. A head CT 5 days later revealed the resolution of cSAH. CONCLUSIONS Infective endocarditis should be considered as an underlying etiology of cSAH, especially when present with multifocal ischemic lesions. Risk factors contributing to the development of cSAH in the IE patient population should be explored in future studies. HIV has not been previously reported in this subgroup and its prevalence should be considered. The prognosis for cSAH in relation to IE is generally favorable.
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Affiliation(s)
- Faisal Khan
- Department of Neurology, Sam Houston State University College of Osteopathic Medicine, Huntsville, TX, USA
| | - Neha Sharma
- Houston Medical Clerkship, Sugar Land, TX, USA
| | - Moin Ud Din
- Houston Medical Clerkship, Sugar Land, TX, USA
| | - Saloni Shirke
- Caribbean Medical University School of Medicine, Willemstad, Curacao, Netherlands Antilles
| | - Saima Abbas
- Department of Infectious Disease, Rockledge Regional Medical Center, Rockledge, FL, USA
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16
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Hannsberger D, Heinola I, di Summa PG, Sörelius K. The value of 18F-FDG-PET-CT in the management of infective native aortic aneurysms. Vascular 2021; 29:801-807. [PMID: 33461432 DOI: 10.1177/1708538120987971] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this systematic literature review was to explore the value of positron emission tomography combined with low-dose computed tomography (18F-FDG-PET-CT) in the diagnostics of infective native aortic aneurysm (INAA). METHODS A systematic literature review was performed using the search terms mycotic- and infected aortic aneurysms in Medline and Sciencedirect databases, published between 1 January 2000 and 1 January 2020. Using the PRISMA statement, articles were scrutinized according to a predefined protocol including: timing of 18F-FDG-PET-CT examination, the maximum standardized uptake value (SUVmax), additional findings on examination, and findings on repeated scanning of 18F-FDG-PET-CT. RESULTS Four studies were included in the analysis, comprising a total of 11 patients. Two studies were single case reports, and two were small case series, all were graded to be of low quality with high risk of bias. All patients were examined with a preoperative 18F-FDG-PET-CT, and 10 (91%) had increased 18F-FDG uptakes. The median SUVmax value was 6.53, range 4.46-9.23. The mean duration of antibiotic therapy prior to 18F-FDG-PET-CT was not known. Two patients were examined with repeated 18F-FDG-PET-CT examinations after treatment, where a decrease in SUVmax values could be demonstrated after successful treatment. CONCLUSION The literature on 18F-FDF-PET/CT for diagnosing infective native aortic aneurysms is scarce. However, there might be a role for 18F-FDF-PET/CT in the management of the disease, in particular for patients with clinical suspicion of INAA without convincing findings on CT. SUVmax values ranging from 4.5 to 6.5 could be guiding and suggestive of metabolic activity in agreement of INAA. However, further conclusions on its usefulness, robustness and specific SUVmax values are premature, and a definitive cut-off value is probably not attainable.
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Affiliation(s)
| | - Ivika Heinola
- Department of Vascular Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Pietro Giovanni di Summa
- Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Karl Sörelius
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Sharma PK, Garisa SS, Kumaran SV, Varma S. Mycotic (Infected) Pseudoaneurysm, a Diagnostic Challenge - Case Series. J Clin Imaging Sci 2020; 10:86. [PMID: 33408961 PMCID: PMC7771397 DOI: 10.25259/jcis_134_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/11/2020] [Indexed: 01/27/2023] Open
Abstract
Mycotic pseudoaneurysm (or infected pseudoaneurysm) is an infectious arteritis, leading to the destruction of the arterial wall with the formation of a blind, saccular outpouching contiguous with the arterial lumen. Delayed management or non-management of mycotic pseudoaneurysms is associated with high morbidity and mortality due to complications such as arterial rupture, hemorrhage, and fulminant sepsis. Earlier diagnosis of mycotic pseudoaneurysm is essential for time management. Multidetector computed tomography (MDCT) is a widely used imaging modality for detecting the mycotic pseudoaneurysm, its characterization, and vascular mapping. MDCT findings of mycotic pseudoaneurysm are blind, saccular outpouching of an artery with irregular arterial wall, perivascular soft-tissue mass, or edema. Uncommon results of MDCT include arterial lumen thrombosis, arterial wall calcification, and perivascular gas. Management of mycotic pseudoaneurysm includes endovascular stenting with graft repair, endovascular embolization, open surgery, medical therapy (intravenous antibiotics), or a combination of these. We report three cases of mycotic pseudoaneurysm affecting aortic isthmus, a segmental branch of the pulmonary artery, and the internal mammary artery. All cases posed a diagnostic challenge, which only on subsequent imaging revealed to be a mycotic pseudoaneurysm.
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Affiliation(s)
- Praveen K Sharma
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sai Sindhura Garisa
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - S Vinod Kumaran
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sparsh Varma
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
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18
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Ono S, Shimogawara T, Hasegawa H. Endovascularly Treated Superficial Femoral Artery Aneurysm Rupture Secondary to Campylobacter fetus Bacteremia: A Case Report. Ann Vasc Surg 2020; 72:664.e1-664.e6. [PMID: 33227459 DOI: 10.1016/j.avsg.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/26/2020] [Accepted: 10/01/2020] [Indexed: 10/22/2022]
Abstract
Degenerative aneurysms of the superficial femoral artery (SFA) are relatively rare and often recognized when they become symptomatic such as rupture. Infected SFA aneurysms are much rarer, especially those caused by Campylobacter fetus bacteremia. We report a case of a 67-year-old woman referred to our hospital owing to the presence of a painful reddish swelling on her left thigh. A huge SFA aneurysm rupture was diagnosed, and endovascular treatment with a covered stent was performed. C. fetus was detected in the blood culture thereafter, and antibacterial therapy was successfully performed without any additional surgical interventions. She remained well without any evidence of indolent infection 19 months after the endovascular treatment. The endovascular approach with appropriate prolonged antibacterial therapy would be a feasible alternative for managing selected infected aneurysm cases.
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Affiliation(s)
- Shigeshi Ono
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan.
| | - Tatsuya Shimogawara
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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19
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Sabaka P, Kachlíková M, Bendžala M, Stankovič I. Mycotic aneurysm as a hidden cause of treatment failure of pyelonephritis caused by Salmonella enterica, serovar Enteritidis. IDCases 2020; 21:e00827. [PMID: 32489877 PMCID: PMC7262434 DOI: 10.1016/j.idcr.2020.e00827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Invasive non-typhoidal Salmonella (NTS) infections are rare in developed countries but their incidence is increasing. One of the most severe complications of extraintestinal NTS infection is mycotic aneurysm. Its natural course is usually fatal and its treatment demands complex interdisciplinary management. We present a case of severe NTS sepsis complicated by mycotic aneurysm of the abdominal aorta and left internal iliac artery and obstructive pyelonephritis. Obstruction of the left ureter was caused by pressure from the left internal iliac artery aneurysm and surrounding edema. The patient presented with clinical symptoms of sepsis and pyelonephritis. Despite abdominal ultrasound and native computed tomography, the mycotic aneurysm eluded initial examination. It remained undiagnosed until the patient presented with recurrent symptoms after stopping 17 days of antimicrobial treatment and was finally revealed by magnetic resonance imaging and contrast computed tomography. The patient was successfully treated by ligation of the left internal iliac artery, partial extirpation of the aneurysm and prolonged parenteral antimicrobial treatment. This case raises concerns that mycotic aneurysm might be present in cases of obstructive pyelonephritis caused by NTS and its early recognition is vital for appropriate management.
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Affiliation(s)
- Peter Sabaka
- Department of Infectology, Geographical Medicine, Faculty, of Medicine, Comenius University in Bratislava, Slovak Republic
- Corresponding author.
| | - Mária Kachlíková
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
| | - Matej Bendžala
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
| | - Igor Stankovič
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
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20
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Higashiura W, Takara H, Kitamura R, Iraha T, Nakasu A, Ishimine T, Yasutani T, Wake M, Tengan T. Endovascular Therapy for Distal Superior Mesenteric Artery Mycotic Aneurysms due to Infective Endocarditis. J Endovasc Ther 2019; 26:879-884. [DOI: 10.1177/1526602819865985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report 3 patients with infective endocarditis who underwent transcatheter arterial embolization for mycotic aneurysm of the distal superior mesenteric artery (SMA). Case Report: Three men (60, 64, and 65 years old) were diagnosed with infective endocarditis. Antibiotics were initiated immediately after admission and continued for several weeks to months. Distal SMA mycotic aneurysm was identified on computed tomography in the vicinity of the ileocolic artery at 33, 26, and 30 days after admission. In case 1, the ileal artery was occluded distal to the aneurysm, with collateral flow to the ileum. In case 2, the mycotic aneurysm was located below the ileocolic artery, which was stenosed distal to the lesion. In case 3, the aneurysm was located on a branch of the ileal artery. Transarterial embolization using microcoils was successfully performed in all patients. No complications associated with embolotherapy or relapse of infection were observed in these 3 patients at 60, 30, and 15 months, respectively. Conclusion: Transcatheter arterial embolization for distal SMA mycotic aneurysm could provide an alternative to open surgery. Anatomical assessment of collateral flow and preprocedure long-term antibiotic therapy could play important roles in preventing bowel ischemia and minimizing the risk of infection relapse.
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Affiliation(s)
- Wataru Higashiura
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Hiroaki Takara
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Ryoichi Kitamura
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Tomotaka Iraha
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Tohru Ishimine
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Tadashi Yasutani
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Minoru Wake
- Department of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Toshiho Tengan
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
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21
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Aftab S, Uppaluri SAS. Mycotic pseudoaneurysm of the aortic isthmus secondary to salmonella infection causing a diagnostic dilemma. J Radiol Case Rep 2019; 13:17-27. [PMID: 31565178 DOI: 10.3941/jrcr.v13i4.3571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mycotic pseudoaneurysms usually arise from an infectious arteritis or mycotic aneurysms secondary to weakening and destruction of the arterial wall resulting in a contained rupture. We report a case of a mycotic pseudoaneurysm affecting the aortic isthmus of the thoracic aorta which is an extremely rare infection. To our knowledge no case report of mycotic pseudoaneurysm of the aortic isthmus secondary to salmonella infection has thus far been described. The specific case we present is also unique in that it posed a diagnostic imaging dilemma where the initial imaging revealed a periaortic mass which could not be accurately characterized and only on subsequent imaging reveal itself to be a thrombosed mycotic pseudoaneurysm. We hope that our case report highlights to the medical community the high degree of suspicion one should have regarding pseudoaneurysms when dealing with a complex mass intimately related to a vascular structure.
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Affiliation(s)
- Syed Aftab
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
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22
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Ben Hammamia M, Ziadi J, Miri R, Ben Mrad M, Ghedira F, Denguir R. Hybrid Repair of a Saccular Aortic Arch Aneurysm Ruptured in the Left Pulmonary Bronchus. Ann Vasc Surg 2019; 57:272.e9-272.e13. [PMID: 30684627 DOI: 10.1016/j.avsg.2018.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
The rupture of aortic arch aneurysm is rare but serious and a life-threatening pathologic condition. We report a case of an 80-year-old woman who was admitted to our department for a rupture of a saccular aortic arch aneurysm in the left pulmonary bronchus. There was no landing zone in the aortic arch. First, we performed a total supra-aortic debranching and a bifurcated graft bypass from the ascending aorta to both the innominate artery and the left carotid artery. Then, we implanted in the aortic arch an endoprosthesis covering the origin of all supra-aortic trunks. Final angiography was satisfactory. The patient died 8 days later due to pulmonary-originated septic shock. Aortic arch hybrid procedures show a variety of severe complications associated with a relevant morbidity, mortality, and reintervention rate. Prognosis of rupture depends not only on the hemorrhage caused but also on the potential infection.
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Affiliation(s)
- Mohamed Ben Hammamia
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Jalel Ziadi
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rim Miri
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Malek Ben Mrad
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Faker Ghedira
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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23
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Buono A, Maloberti A, Bossi IM, Piccaluga E, Piccalò G, Oreglia JA, Moreo A, Russo CF, Oliva F, Giannattasio C. Mycotic coronary aneurysms. J Cardiovasc Med (Hagerstown) 2019; 20:10-15. [DOI: 10.2459/jcm.0000000000000734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Abstract
Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.
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Affiliation(s)
- Sureshkumar Nagiah
- Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Rassam Badbess
- Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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25
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Li PS, Tsai CL, Hu SY, Lin TC, Chang YT. Spontaneous hemothorax caused by ruptured multiple mycotic aortic aneurysms: a case report and literature review. J Cardiothorac Surg 2017; 12:109. [PMID: 29197388 PMCID: PMC5712197 DOI: 10.1186/s13019-017-0665-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Abstract
Background Mycotic aortic aneurysm (MAA) is a rare clinical entity with an incidence of 1-3%, but it is a life-threatening infection of aorta characterized by dilatation of aorta with false lumen. Multiple MAAs have been reported rarely with an incidence of 0.03% and associated with a high mortality rate of 80% if ruptured. Case presentation A hypertensive and diabetic 78-year-old man visited our emergency department complaining intermittent dull and tingled pain over the left flank region for 1 week. Chest X-ray showed left pleural effusion and hemothorax was confirmed by thoracocentesis. Computed tomography (CT) of chest demonstrated multiple thoracic aortic aneurysms and the pathological findings disclosed the diagnosis of multiple MAAs. He was discharged under an uneventful condition post-surgical aortic repair with adequate intravenous antibiotics for 4 weeks. Conclusions CT scan may make a definite diagnosis of multiple MAAs and management with surgical debridement, aortic repair and full-course antibiotics for Gram-positive coccus and/or Gram-negative bacillus is recommended.
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Affiliation(s)
- Po-Sung Li
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Lin Tsai
- Division of Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan. .,Department of Nursing, Central Taiwan Univeristy of Science and Technology, Taichung, Taiwan. .,, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
| | - Tzu-Chieh Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan
| | - Yao-Tien Chang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
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26
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Bedmutha AS, Singh N, Shivdasani D. Metabolic Imaging as a Novel Strategy in Evaluation of Mycotic Abdominal Aortic Aneurysm: A Case Report and Brief Clinical Review. Indian J Nucl Med 2017; 32:336-339. [PMID: 29142353 PMCID: PMC5672757 DOI: 10.4103/ijnm.ijnm_81_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is an uncommon entity with high mortality. Etiologically, they are classified as inflammatory and infective (mycotic), the latter being less common. Clinical presentation, laboratory investigations, and treatment for these may considerably overlap. However, choice of management and the need for surgical intervention depends on factors such as size and progression of aneurysm, persistent symptoms, and presence or absence of distant pathology. Although computed tomography (CT) is the gold standard for AAA, in selected cases, especially in infected AAA, fluorodeoxyglucose positron emission tomography-CT can provide valuable information.
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Affiliation(s)
- Akshay Sharad Bedmutha
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Natasha Singh
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Divya Shivdasani
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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27
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Romero Lozano M, Castejón Navarro B, Duque Santos A, Reyes Valdivia A, Ocaña Guaita J. Tratamiento quirúrgico de aneurisma micótico con preservación de injerto renal. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2014.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg 2016; 63:1638-46. [PMID: 26951998 DOI: 10.1016/j.jvs.2016.01.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/03/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported series. The current incidence of inferior mesenteric artery (IMA) aneurysm is unknown. However, infective causes (mycotic) of SMA and IMA aneurysm as a result of primary, secondary, and cryptogenic etiology remain a separate entity and attain fewer cases in the literature. Currently, there is no consensus on their presentation, diagnosis, and overall management. METHODS A systematic review and meta-aggregation of literature from 1944 to March 2015 in the English language and of adult subjects in MEDLINE, Ovid, CINAHL, and the Cochrane database was conducted. RESULTS The median age of patients with SMA aneurysm was 36 (range, 14-92) years, with a significant male predominance (73% vs 27%). In order of prevalence, abdominal pain (n = 25; 65%), low-grade fever (n = 23; 60%), malaise (n = 10; 26%), weight loss (n = 9; 23%), and nausea and vomiting (n = 8; 20%) were the most common presenting signs and symptoms. The most common microorganism was Streptococcus (n = 18; 47%), followed by Staphylococcus (n = 11; 28%). The investigative modality of choice was computed tomography (n = 22; 57.8%), followed by ultrasonography of the abdomen (n = 9; 23%). Primary etiology was noted in 5.4%, secondary in 71%, and cryptogenic in 13% of all cases. Aneurysmectomy alone was associated with bowel resection in four cases (10.5%), whereas aneurysmectomy with interposition vein grafting required no further intervention. The inpatient mortality after surgery was 7.8%, and the overall mortality was 15%. The median follow-up was 12 months (range, 2-120 months). The median age of patients with IMA aneurysm was 48 (range, 22-64) years, with a male predominance of 2:1 and abdominal pain in all cases (n = 3; 100%). The most common microorganism was Streptococcus (n = 2; 66.6%), and the operation of choice was aneurysmectomy (n = 2; 66.6%) after computed tomography scan (n = 3; 100%) as an investigative modality of choice. CONCLUSIONS The pentad of abdominal pain, pyrexia of unknown origin, malaise, weight loss, and nausea remains the most convincing presentation of mycotic aneurysms of the SMA and IMA. Computed tomography is the investigative modality of choice, and such patients are best served with aneurysmectomy alone in IMA aneurysms and interposition vein grafting in SMA aneurysms after initiation of antimicrobial therapy on suspicion of the diagnosis.
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29
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Deipolyi AR, Rho J, Khademhosseini A, Oklu R. Diagnosis and management of mycotic aneurysms. Clin Imaging 2016; 40:256-62. [DOI: 10.1016/j.clinimag.2015.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 02/06/2023]
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30
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Jones AD, Murray AM, Downing R. Listeria Infected Pseudoaneurysm of the Superficial Femoral Artery. Ann Vasc Surg 2016; 31:208.e15-7. [DOI: 10.1016/j.avsg.2015.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/30/2015] [Accepted: 09/03/2015] [Indexed: 01/16/2023]
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31
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Jones KA, Choong AMTL, Canham N, Renton S, Pollitt R, Nesbitt M, Kopcke D, Islam L, Buckley J, Ghali N, Vandersteen A. A combined vascular surgical and clinical genetics approach to diffuse aneurysmal disease. Ann R Coll Surg Engl 2015; 97:e73-6. [PMID: 26264107 DOI: 10.1308/003588415x14181254790121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report two patients who presented with extensive aneurysmal disease, in association with minimal external physical signs. Patient 1 remained genetically undiagnosed despite multiple structural, biochemical and genetic investigations. He made a good recovery following surgery for popliteal and left axillary artery aneurysms. Patient 2 was diagnosed with vascular type Ehlers-Danlos syndrome, associated with a high degree of tissue and blood vessel fragility, and is being managed conservatively. Early multidisciplinary assessment of such patients facilitates accurate diagnosis and management.
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Affiliation(s)
- K A Jones
- Outer London North West Vascular Unit, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
| | | | - N Canham
- North West London Regional Genetics Service, Level 8V, Saint Mark's Hospital, London North West Healthcare NHS Trust , UK
| | - S Renton
- Outer London North West Vascular Unit, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
| | - R Pollitt
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospitals NHS Foundation Trust , UK
| | - M Nesbitt
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospitals NHS Foundation Trust , UK
| | - D Kopcke
- Department of Radiology, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
| | - L Islam
- West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust , UK
| | - J Buckley
- Department of Infectious diseases, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
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Lopes Oliveira MJ, Semedo CMP, Quintela MJG, Fragata IMR, Coelho CCG, Valejo Coelho PJ. Pseudoaneurysm of the facial artery territory in an odontogenic infection setting. Oral Radiol 2015. [DOI: 10.1007/s11282-015-0216-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yew KL, Choy CN, Kam JY, Kang Z. Intracoronary blood sampling with a microcatheter for the diagnosis of giant infective coronary aneurysm: Melioidosis of coronary artery mycotic aneurysm. Int J Cardiol 2015; 187:530-1. [PMID: 25863294 DOI: 10.1016/j.ijcard.2015.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Kuan Leong Yew
- Cardiology Department, Sarawak General Hospital Heart Center, 94300 Kota Samarahan, Sarawak, Malaysia.
| | - Chun Ngok Choy
- Cardiology Department, Sultanah Aminah Hospital, 80100 Johor Bahru, Johor, Malaysia
| | - Ji Yen Kam
- Cardiology Department, Sultanah Aminah Hospital, 80100 Johor Bahru, Johor, Malaysia
| | - Zarrin Kang
- Cardiology Department, Sarawak General Hospital Heart Center, 94300 Kota Samarahan, Sarawak, Malaysia
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Dua A, Kuy S, Desai SS, Kumar N, Heller J, Lee CJ. Diagnosis and management of a ruptured popliteal mycotic pseudoaneurysm. Vascular 2014; 23:419-21. [PMID: 25245048 DOI: 10.1177/1708538114551193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infected popliteal aneurysms are a rare but high-risk pathology that may present as a surgical emergency with acute rupture and sepsis. Management of acute ischemia in the presence of systemic sepsis is challenging and requires timely diagnosis, rapid intervention, and multidisciplinary communication to ensure an optimum outcome for both life and limb in these patients. We report on a case of a ruptured mycotic popliteal artery aneurysm as a consequence of septic embolization from infective endocarditis managed by reverse saphenous vein bypass. The clinical presentation, diagnostic process, and approach to management along with a literature review on mycotic popliteal aneurysm are presented in this case report.
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Affiliation(s)
- Anahita Dua
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - SreyRam Kuy
- Department of Surgery, Louisiana State University, Shreveport and Overton Brooks Veterans Affairs Medical Center, Shreveport, USA
| | - Sapan S Desai
- Department of Vascular Surgery, Southern Illinois University, Springfield, USA
| | | | - Jennifer Heller
- Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Center, Maryland, USA
| | - Cheong J Lee
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
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Bodilsen J, Vammen S, Fuursted K, Hjort U. Mycotic aneurysm caused by Burkholderia pseudomallei in a previously healthy returning traveller. BMJ Case Rep 2014; 2014:bcr2013202824. [PMID: 25246454 PMCID: PMC4173190 DOI: 10.1136/bcr-2013-202824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/03/2022] Open
Abstract
Burkholderia pseudomallei is a common cause of serious, difficult to treat infections in South-East Asia and Northern Australia, but is a rare imported pathogen in the USA and Europe. We report a case of a patient with a mycotic aneurysm caused by B. pseudomallei in a previously healthy returning traveller. The patient presented with 4 weeks of abdominal pain and intermittent fever after a brief vacation in Thailand. The aneurysm was excised and replaced by an autologous deep vein graft, and the patient was treated for 6 months with antibiotics adjusted according to postoperative renal impairment. Twenty-four months after surgery the patient is well and without relapse.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Sten Vammen
- Department of Vascular Surgery, Aarhus University Hospital Skejby, Aarhus N, Denmark
| | - Kurt Fuursted
- Bacteriology Reference Department, Statens Serum Institut, Copenhagen S, Denmark
| | - Ulla Hjort
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
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Melendez BA, Hollis HW, Rehring TF. Mycotic popliteal aneurysm rupture secondary to Campylobacter fetus. Ann Vasc Surg 2014; 29:122.e9-11. [PMID: 24930978 DOI: 10.1016/j.avsg.2014.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/01/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mycotic aneurysms of the popliteal artery are uncommon. Popliteal aneurysms rarely rupture. The authors present the second reported case of popliteal artery rupture as a result of Campylobacter fetus infection. This report confirms the arterial destructive potential of C. fetus infection in a peripheral artery. METHODS An 85-year-old male who had previously undergone endovascular abdominal aortic aneurysm repair in 2007 presented with positive blood cultures for C. fetus. No endocarditis was detected. No periprosthetic fluid to suggest aortic endograft infection was present. During hospitalization for sepsis, he developed acute right knee pain and swelling. A 5.2-cm popliteal aneurysm, with contained rupture, was found on ultrasound and confirmed by computed tomography and angiography. Recommendations for treatment and a literature review are provided. RESULTS This patient was successfully managed with total excision of the aneurysm via a posterior approach with reconstruction through a medial approach using autologous saphenous vein bypass. Culture-directed antibiotic therapy (6 weeks of intravenous ertapenem) to eradicate the pathogen completed the therapy. The patient is doing well at 18- month follow-up. CONCLUSIONS Mycotic popliteal aneurysm associated with C. fetus is a rare but potentially fatal condition. Isolating C. fetus should alert the surgeon to the peripheral arterial destructive potential of this pathogen, as manifested by acute rupture in this patient. Traditional resection through a posterior approach and revascularization through noncontaminated tissue with culture-directed therapy are the treatments of choice.
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Affiliation(s)
- Barbara A Melendez
- Department of Graduate Medical Education, Exempla Saint Joseph Hospital, Denver, CO.
| | - Harris W Hollis
- Department of Graduate Medical Education, Exempla Saint Joseph Hospital, Denver, CO
| | - Thomas F Rehring
- Department of Vascular Therapy, Colorado Permanente Medical Group, Denver, CO
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Multiple Mycotic Aneurysms Infected with Haemophilus influenzae. Ann Vasc Surg 2014; 28:741.e11-3. [DOI: 10.1016/j.avsg.2013.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 06/20/2013] [Accepted: 07/15/2013] [Indexed: 01/16/2023]
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Jenkins WSA, Chin C, Rudd JHF, Newby DE, Dweck MR. What can we learn about valvular heart disease from PET/CT? Future Cardiol 2013; 9:657-67. [DOI: 10.2217/fca.13.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Valvular heart disease is a major cause of morbidity and mortality, and with an aging population, its prevalence is increasing. Here, we review the evolving use of positron emission tomography/computed tomography in valvular heart disease, with particular focus on calcific aortic stenosis and infective endocarditis. In principle, the activity of any pathological process can be studied, as long as an appropriate radiotracer can be developed. We will review some of the early data using established tracers in the above and other conditions, providing discussion as to the future research and clinical roles of these techniques. Furthermore, we will discuss the potential impact of novel tracers that are currently under development or testing in preclinical models. It is hoped that such advanced imaging might improve the diagnosis, treatment and outlook for patients with valvular heart disease.
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Affiliation(s)
- William SA Jenkins
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Calvin Chin
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
- National Heart Center Singapore, SingHealth, Singapore
| | - James HF Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
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Watura K, Katsimihas M, Williams M. Streptococcus pneumoniae mycotic aneurysm with contiguous vertebral discitis treated by endovascular aortic repair and antibiotics. BMJ Case Rep 2013; 2013:bcr-2012-008499. [PMID: 23813992 DOI: 10.1136/bcr-2012-008499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old man was admitted with a history of right upper quadrant and left iliac fossa pain and raised inflammatory markers. Initial investigations, including contrast-enhanced CT scan of the abdomen and pelvis, were reported as normal. Following readmission 2 months later with thoracolumbar back pain and recurrent fevers, an MRI showed T11/12 discitis and an adjacent mycotic aneurysm of the aorta. CT angiogram confirmed an 8 cm mycotic aneurysm. A second, more distal aneurysm was found located at the left common femoral artery. The aortic aneurysm was treated by antegrade stenting. The left common femoral artery aneurysm was excised. The patient was also treated with antibiotics. He made a good recovery and was well 8 months later apart from mild residual thoracolumbar spinal pain. To date, he has been followed up for 1 year and remains asymptomatic.
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Affiliation(s)
- Karen Watura
- University of Birmingham Medical School, Birmingham, UK.
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41
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Affiliation(s)
- Natasha Noel
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
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Jolobe OMP. Coronary artery mycotic aneurysm is the diagnostic challenge of the stent era. QJM 2012; 105:499-500. [PMID: 22383689 DOI: 10.1093/qjmed/hcs039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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