Mycotic aneurysms

A surgical case of excision of infected aneurysm arising from anterior interosseal artery following infectious endocarditis

Infected aneurysm (IA) of the anterior interosseal artery (AIA), the first branch of the ulnar artery, is an infrequent but serious complication of infectious endocarditis (IE). We report a successful case of excision of IA arising from AIA. In this case, the IA expanded and adhered to the ulnar artery, resulting in occlusion of the ulnar artery. Reconstruction of the ulnar artery was not needed by the preoperative evaluation and the intraoperative occlusion testing. We discuss surgical treatment of IA following IE in upper extremities.

Medical errors: an introduction to concepts

The prevalence of medical errors in health care systems has generated immense interest in recent years. The research on adverse events in hospitalized populations has consistently revealed high rates of adverse events. Some of these adverse events result from medical errors and a majority of these errors may be preventable. These errors can occur anywhere and at anytime in health care processes. The consequences of these errors may vary from little or no harm to being ultimately fatal to the patients. It is important to recognize that a degree of error is inevitable in any human task and human fallibility in health care should be accepted. The underlying precursors for many of these human errors may primarily be attributed to latent systemic factors inherent in today's increasingly complex health care system. The focus of adverse event analyses on individual shortcomings without appropriate attention to system issues leads to ineffective solutions. The cognitive influence on medical decision-making and error generation is also significant and should not be discounted.

Purulent pericarditis due to group B streptococcus and mycotic aneurysm of the ascending aorta: case report

A 61-year-old female, with a history of uterine and cervical cancer treated with radical hysterectomy and 2 years of postoperative chemotherapy, presented to the emergency department with dyspnea on exertion. Computed tomography of the chest revealed a large pericardial effusion and a sacciform aneurysm of the ascending aorta. The patient subsequently underwent emergency pericardiocentesis with drainage of approximately 330 ml of a bloody and turbid effusion. Cultures from the effusion yielded group B streptococcus. Multiple organ failure and disseminated intravascular coagulation syndrome occurred in the acute phase, but gradually improved with continuous antibiotic therapy. On the 194th hospital day, in situ reconstruction of the ascending aorta was successfully performed using a synthetic graft. Although rarely reported, both purulent bacterial pericarditis and mycotic aneurysm can be life-threatening.

Septic endarteritis following percutaneous transluminal coronary angioplasty

We report a case of bacterial arteritis of the external iliac artery complicated by mycotic aneurysm following coronary angioplasty. To our knowledge, this is the first reported instance of arterial wall infection caused by coronary angioplasty at a distance from the insertion site equal to the length of the sheath.

Diagnostic features and management of bacterial arteritis with false aneurysm formation

Primary bacterial arteritis with false aneurysm formation is an uncommon condition. This report presents seven patients admitted to one unit over a 5-year period. Interesting aspects of the clinical presentation are discussed. The importance of surgical debridement, extra-anatomic bypass, antibiotic therapy and antibiotic irrigation of the infected aneurysm cavity is stressed. The relative merits of extra-anatomic bypass and in situ grafting for aortic infection are discussed. By following these principles, this series of patients have had a successful surgical outcome and all the signs of infection have been eradicated.

Mycotic aneurysm of left subclavian artery

Bacterial endarteritis is rare and usually affects the abdominal aorta. A case of bacterial left subclavian arteritis complicated by mycotic aneurysm is presented. An early diagnosis of infective arteritis was made based on a history of fever, sweats, rigors, and a progressive macular rash, polyarthralgia splinter haemorrhage (limited to the left arm), and a loud left subclavian bruit on admission. A mycotic aneurysm was diagnosed by computed tomography and treated surgically. In cases of endarteritis the possibility of a mycotic aneurysm should be borne in mind even when there is no evidence of endocarditis.

Bacterial intracranial aneurysms

This is a retrospective study of 25 patients with bacterial intracranial aneurysms treated in a single department over a 20-year period. The clinical presentation, investigation and treatment of these patients is discussed. The outcome of the treatment is assessed and is thought to be not as poor as previously reported.

Mycotic aneurysm in a digital artery: case report and literature review

A mycotic aneurysm of the common digital artery at its junction with the palmar arch, extending into the ulnar proper digital artery of the index finger, is reported in a patient with endocarditis. A review of the English-language literature revealed no case of mycotic aneurysm in a digital artery. Diagnosis of the aneurysm was established noninvasively by ultrasound. Because this patient lacked a radial proper digital artery to the finger, the aneurysm was managed by excision and revascularization with a bypass graft from the long finger. Postoperative circulatory monitoring was facilitated by a pulse oximeter.

Ruptured mycotic aneurysms

Two cases of ruptured mycotic aneurysms in intravenous drug abusers are presented. The pathogenesis, clinical presentation, radiological diagnosis, and management of mycotic aneurysms are discussed. Early diagnosis and therapy are required to salvage these patients.

Total therapeutic embolization of the kidney for hypertension in a child with a mycotic aneurysm

A 7-year-old boy with bacterial endocarditis developed renal artery mycotic aneurysm and diffuse distal occlusions of the renal branches. Blood pressure in the patient returned to normal after obliteration of flow to the left kidney with Gelfoam, Ivalon, and a Gianturco coil. An end loop of the coil used for embolization remained in the lumen of the aorta against its lateral side. Improper coil placement did not result in complications; the boy later died due to neurologic and pulmonary complications. We discuss the therapeutic potential of renal embolization, as well as the risks of particulate and ethanol embolization, in the treatment of renal vascular hypertension from mycotic aneurysms.

Ruptured mycotic aneurysm during a computed tomogram brain scan

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Pseudoaneurysm of the thoracic aorta: a late complication of umbilical artery catheterization

Pseudoaneurysm of the thoracic aorta developed in an infant eight months following neonatal catheterization of the umbilical artery. Infection and placement of a stiff polyvinyl chloride catheter in the thoracic aorta appear to be the etiological factors. Preoperative diagnosis was posterior mediastinal tumor, and pseudoaneurysm was not included in the differential. Dacron graft patch angioplasty repair using partial cardiopulmonary bypass was successful. Postoperatively the patient has done well with no pressure gradient. Pseudoaneurysm should be suspected whenever a mediastinal mass appears in children who have had thoracic placement of umbilical artery catheters.

Mycotic aneurysm of the aorta

The radiographic and pathologic features of 13 cases of mycotic aneurysm of the aorta were reviewed retrospectively. In four cases the mycotic aneurysm was associated with bacterial endocarditis following aortic valve replacement, and in nine cases it was associated with spontaneous bacterial endocarditis. Postmortem examination revealed that the mycotic aneurysm was most frequently found in cases with bicuspid aortic valves. In all cases the chest radiograph revealed cardiomegally, usually with pulmonary vascular congestion. In the six patients in whom the diagnosis was established angiographically, the aneurysm was manifested by an irregular saccular collection of contrast medium under one of the coronary arteries. Mycotic aneurysms must be differentiated from other lesions with similar angiographic findings, such as a congenital aneurysm of the sinus of Valsalva, prolapse of an aortic cusp through a membranous ventricular septal defect, and a congenital aortic-left ventricular tunnel.

Leaking mycotic aneurysm of renal artery in a child

A case of staphylococcal endocarditis, complicated by a leaking mycotic aneurysm of the right artery in a boy is presented. An emergency nephrectomy was lifesaving. The clinical course and pathology are discussed and the literature is reviewed.

Mycotic aneurysm of the ascending aorta following coronary revascularization

A large mycotic aneurysm of the ascending aorta that appeared two years, three months after triple coronary revascularization is described. Hypothermia and total circulatory arrest were used in excising the aneurysm, and sterilization of the mediastinum was achieved with systemic and local antibiotic therapy. Follow-up at eight months showed a satisfactory postoperative course and no recurrence of mediastinal infection.

Localised aneurysms of the descending thoracic aorta

The clinical, roentgenographic and aortographic data were reviewed in 12 patients with localised descending, thoracic aortic aneurysms. The current study indicates that arteriosclerotic peripheral vascular disease not infrequently produced localised saccular aneurysms of the descending thoracic aorta. Characteristic symptomatology was unusual; most aneurysms were detected as incidental roentgenographic findings. The aneurysms projected from the posteroloteral aspect of the aorta and roentgenographically appeared as left hilar masses or left retrocardiac masses when located in the mid and lower descending thoracic aorta, respectively. Specific rim calcification or vertebral erosion was not encountered in any case. During aortography only a small portion of the aneurysm was outlined with contrast material due to partial obliteration of the aneurysmal cavity with thrombus.

Mycotic aneurysms of coronary arteries

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