1
|
Somers T, Nies HMJM, Kouijzer IJE, Lee PY, Morshuis WJ, Geuzebroek GSC. Mycotic aortic aneurysms: characteristic macroscopic findings in a case series. SCAND CARDIOVASC J 2024; 58:2341696. [PMID: 38616531 DOI: 10.1080/14017431.2024.2341696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/06/2024] [Indexed: 04/16/2024]
Abstract
Infected or mycotic aortic aneurysms (MAAs) are a rare type of aneurysms. Due to the high risk of rupture, MAAs are life-threatening conditions. Early diagnosis and treatment are necessary, yet MAAs are usually found coincidentally. We report 10 patients with MAAs in whom macroscopically, similar coined-sized lesions of the inner aortic wall were seen in all cases. When a coin-sized lesion in the inner aortic wall is seen during open surgical repair of an aortic aneurysm, the surgeon should consider an infectious cause. Microbiological tissue samples should be collected, and additional targeted antibiotic therapy should be started.
Collapse
Affiliation(s)
- Tim Somers
- Department of Cardio-thoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hedwig M J M Nies
- Department of Cardio-thoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pui Yuen Lee
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim J Morshuis
- Department of Cardio-thoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardio-thoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Sasaki H, Numata Y, Kamiya S, Sone Y, Sasaki O. An Escherichia coli-Induced Distal Arch Aneurysm Presenting With Hemoptysis. Cureus 2023; 15:e40654. [PMID: 37476141 PMCID: PMC10356179 DOI: 10.7759/cureus.40654] [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: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Infected thoracic aneurysms are a rare and potentially life-threatening condition that present with non-specific symptoms. We describe here a case of an 83-year-old female who presented to the emergency department with the chief complaint of vomiting blood. The patient had presented to the emergency department 40 days earlier with abdominal pain, fever, and leukocytosis. She had a medical history of traumatic liver injury resulting in bile duct stenosis, necessitating percutaneous transhepatic gallbladder drainage and subsequent bile duct-jejunal anastomosis 25 years ago. Emergency contrast-enhanced computed tomography (CT) revealed an irregular distal arch aneurysm. According to the patient's present symptoms, CT findings, and medical history, infected thoracic aneurysm was suspected. Total arch replacement was performed promptly, followed by thorough antibiotic therapy. Following successful treatment, the patient's condition stabilized, and she was transferred to a rehabilitation facility for further recovery.
Collapse
Affiliation(s)
- Hideki Sasaki
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Yukihide Numata
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Shinji Kamiya
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Yoshiaki Sone
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Osamu Sasaki
- Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
- Internal Medicine, Kouiki Mombetsu Hospital, Mombetsu, JPN
| |
Collapse
|
3
|
Patel CB, Wademan B, Galvin SD. A life-threatening aortic complication from fishbone ingestion. ANZ J Surg 2023; 93:424-425. [PMID: 35751479 DOI: 10.1111/ans.17872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Cheerag Bharatbhai Patel
- Department of Cardiothoracic Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Brecon Wademan
- Department of Cardiothoracic Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Sean D Galvin
- Department of Cardiothoracic Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| |
Collapse
|
4
|
Liu C, Huang S, Hsu C. A fatal masquerade in pneumonia: Ruptured thoracic aortic aneurysm. Clin Case Rep 2022; 10:e05285. [PMID: 35035967 PMCID: PMC8752455 DOI: 10.1002/ccr3.5285] [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: 09/25/2021] [Revised: 12/09/2021] [Accepted: 12/23/2021] [Indexed: 11/08/2022] Open
Abstract
We described an 87-year-old man who presented with fever and hemoptysis. Nosocomial pneumonia was initially suspected. However, the patient had worsening hemoptysis despite defervescence. Chest computed tomography disclosed ruptured thoracic aortic aneurysm. Emergent surgery was then commenced for adequate treatment.
Collapse
Affiliation(s)
- Ching‐Han Liu
- Division of CardiologyDepartment of MedicineKaohsiung Armed Forces General HospitalKaohsiungTaiwan
- Division of CardiologyDepartment of MedicineNational Defense Medical CenterTri‐Service General HospitalTaipeiTaiwan
| | - Shih‐Chung Huang
- Division of CardiologyDepartment of MedicineKaohsiung Armed Forces General HospitalKaohsiungTaiwan
- Division of CardiologyDepartment of MedicineNational Defense Medical CenterTri‐Service General HospitalTaipeiTaiwan
| | - Ching‐Tsai Hsu
- Division of CardiologyDepartment of MedicineNational Defense Medical CenterTri‐Service General HospitalTaipeiTaiwan
- Division of CardiologyDepartment of MedicineTaoyuan Armed Forces General HospitalTaoyuanTaiwan
| |
Collapse
|
5
|
Tan N, Shi Y, Xu D, Wang J. Unusual cause of gastrointestinal bleeding in an 84-year-old woman: a miraculous survival from an aortoduodenal fistula repair. BMJ Case Rep 2021; 14:e244318. [PMID: 34518182 PMCID: PMC8438823 DOI: 10.1136/bcr-2021-244318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/04/2022] Open
Abstract
An 84-year-old woman presented acutely with dizziness, fatigue and a total of 800 mL of fresh per rectum (PR) bleeding. The significant history of abdominal aortic aneurysm repair 5 years ago included multiple episodes of endovascular leak around the stent associated with abscess of left psoas major, left abdominal wall abscess with sinus formation, appendicitis with abscess formation, and acute pancreatic and chronic cholecystitis with multiple gallstones in the 7 months prior to this presentation. During the preceding 7 months, the patient was stabilised with an intravenous proton pump inhibitor, blood transfusions and Intensive Care Unit (ICU) management for the assumed diagnosis of stress ulcers over multiple hospital admissions. Imaging with CT scan of the abdomen made the more accurate diagnosis of acute gastrointestinal haemorrhage caused by a fistula between the distal duodenum and aorta, which was later surgically confirmed. Removal of infected stents and axillobifemoral bypass were performed with a successful recovery.
Collapse
Affiliation(s)
- Nicole Tan
- Curtin Medical School, Curtin University Bentley Campus, Perth, Bentley, Australia
| | - Yi Shi
- Vascular Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Dan Xu
- Curtin Medical School, Curtin University Bentley Campus, Perth, Bentley, Australia
- Curtin School of Population Health, Curtin University Bentley Campus, Perth, Bentley, Australia
- Medical Education and General Practice, Sun Yan-sen University of Medical Sciences, Guangzhou, China
| | - Jinsong Wang
- Vascular Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| |
Collapse
|
6
|
Nathani A, Ghamande S, Sanchez JF, White HD. Subclavian artery aneurysm: a rare cause of massive haemoptysis. BMJ Case Rep 2021; 14:14/3/e241225. [PMID: 33687930 PMCID: PMC7944985 DOI: 10.1136/bcr-2020-241225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old man was admitted to the intensive care unit with massive haemoptysis. CT of the chest revealed a necrotic right upper lobe mass. Angiography of his thoracic vasculature revealed a pseudoaneurysm in the right subclavian artery with active contrast extravasation. This anatomic deformity was stented and coiled with the assistance of interventional radiology. Bronchoscopy with lavage and brushings of the right upper lobe mass revealed fungal hyphae and positive galactomannan, supporting that the patient developed invasive pulmonary aspergillosis leading to a mycotic pseudoaneurysm of the right subclavian artery followed by massive haemoptysis.
Collapse
Affiliation(s)
- Alireza Nathani
- Baylor Scott and White Central Texas, Temple, Texas, USA .,Pulmonary & Critical Care, Baylor Scott and White Central Texas, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Central Texas, Temple, Texas, USA.,Pulmonary & Critical Care, Baylor Scott and White Central Texas, Temple, Texas, USA
| | - Juan F Sanchez
- Baylor Scott and White Central Texas, Temple, Texas, USA.,Pulmonary & Critical Care, Baylor Scott and White Central Texas, Temple, Texas, USA
| | - Heath D White
- Baylor Scott and White Central Texas, Temple, Texas, USA.,Pulmonary & Critical Care, Baylor Scott and White Central Texas, Temple, Texas, USA
| |
Collapse
|
7
|
Chang HS, Kim SJ, Kim YH. Contained Rupture of a Thoracic Aortic Aneurysm Mimicking a Malignant Tumor: a Case Report. Nucl Med Mol Imaging 2020; 54:315-318. [PMID: 33282003 DOI: 10.1007/s13139-020-00668-1] [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: 07/28/2020] [Revised: 09/10/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
An 81-year-old man underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to evaluate a mediastinal mass, which was discovered during the investigation for hemoptysis. The periphery of the mass abutting the aortic arch demonstrated heterogeneously increased FDG uptake, whereas most of the central portion of the mass was photopenic. The mass turned out to be an atheromatous organizing hematoma associated with contained aortic rupture.
Collapse
Affiliation(s)
- Hyung Seok Chang
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Soo Jeong Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Young Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| |
Collapse
|