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Hjembæk-Brandt J, Homøe P. Pyomyositis in the sternocleidomastoid muscle in a previously healthy 36-year-old woman. Ugeskr Laeger 2024; 186:V11230750. [PMID: 38704724 DOI: 10.61409/v11230750] [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: 05/07/2024]
Abstract
Pyomyositis is a bacterial infection of striated muscle, usually located to muscles in the extremities or pelvis. We present a microbiologically unique case report of pyomyositis in the sternocleidomastoid muscle (the first of its kind in Denmark) caused by Staphylococcus epidermidis, S. capitis and possibly Streptococcus pneumoniae. Pyomyositis is very rare but can lead to critical complications such as endocarditis and sepsis. It is therefore important to know the condition when evaluating an infected patient with muscle pain. Treatment consists of antibiotics and - if relevant - surgical abscess drainage.
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Affiliation(s)
| | - Preben Homøe
- Øre-, Næse- og Halskirurgisk Afdeling, Sjællands Universitetshospital, Køge
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Roy CF, Saint-Martin C, Mascarella M, Girsowicz E, Daniel SJ, Gurberg J, Duval M, Yeung JC. Ruptured Internal Carotid Artery Mycotic Pseudoaneurysm as Sequela to a Retropharyngeal Abscess in an Immunocompetent Child. EAR, NOSE & THROAT JOURNAL 2023:1455613231198990. [PMID: 37705374 DOI: 10.1177/01455613231198990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Affiliation(s)
- Catherine F Roy
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christine Saint-Martin
- Department of Pediatric Radiology, McGill University Health Centre, Montreal, QC, Canada
| | - Marco Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Elie Girsowicz
- Department of Vascular Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Sam J Daniel
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Joshua Gurberg
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Melanie Duval
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Jeffrey C Yeung
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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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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Lui DH, Patel S, Khurram R, Joffe M, Constantinou J, Baker D. Mycotic internal carotid artery pseudoaneurysm secondary to Mycobacterium tuberculosis. J Vasc Surg Cases Innov Tech 2022; 8:251-255. [PMID: 35516167 PMCID: PMC9065464 DOI: 10.1016/j.jvscit.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Mycobacterium tuberculosis is a rare causative agent for mycotic aneurysms of the extracranial carotid arteries. We describe a case of acute mycotic pseudoaneurysm and abscess in the right proximal internal carotid artery in close proximity to the carotid bifurcation, and subsequent management with antibiotic therapy, surgical debridement and resection with an end-to-end anastomosis.
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Affiliation(s)
- Dennis H. Lui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
- Divison of Surgery and Interventional Science, University College London, London, UK
- Correspondence: Dennis H. Lui, MBChB, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond St, London NW3 2QG, UK
| | - Shreena Patel
- Department of Clinical Radiology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Ruhaid Khurram
- Department of Clinical Radiology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Michael Joffe
- Department of Clinical Radiology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Jason Constantinou
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Daryl Baker
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
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Mycotic Aneurysm of Internal Carotid Artery Secondary to Livestock-associated Methicillin-resistant Staphylococcus Aureus Clonal Complex CC398. Ann Vasc Surg 2021; 78:379.e7-379.e10. [PMID: 34481883 DOI: 10.1016/j.avsg.2021.06.031] [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: 03/16/2021] [Revised: 05/17/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022]
Abstract
The aim of this article is to present a case of mycotic aneurysm of internal carotid artery secondary to livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) treated with resection and common-to-internal carotid artery bypass with autologous vein graft in a male pig farmer. A 69-year-old man, pig farmer, with recent dental extraction was admitted with a right cervical pulsatile mass, dysphonia, pain, leukocytosis and elevated C-reactive protein (CRP). Ultrasonography (US) and computed tomography angiography (CTA) showed a 3.9 × 4.5 cm mycotic aneurysm of right internal carotid artery with hypermetabolic uptake in positron emission tomography (PET) scan. Resection of the mycotic aneurysm and a common-to-internal carotid artery bypass with major saphenous vein graft were performed. LA-MRSA clonal complex (CC) 398 was detected in intraoperative samples and antibiotic therapy was changed according to antibiogram. Patient was discharged at the seventh postoperative day and received antibiotic therapy for 6 weeks. US 12 months later showed patency of the bypass without collections. Mycotic aneurysms of internal carotid artery are very infrequent. MRSA isolation is rare, and to the best of our knowledge this is the first case caused by multi-drug resistant LA-MRSA CC398. The treatment includes mycotic aneurysm resection and reconstruction with venous graft bypass plus intensive antibiotic therapy.
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Molina G, Mesías C, Calispa J, Arroyo K, Jaramillo K, Lluglla L, Gutierrez B, Gálvez P. Mycotic pseudoaneurysm of the extracranial carotid artery, a severe and rare disease, a case report. Int J Surg Case Rep 2020; 71:382-385. [PMID: 32487475 PMCID: PMC7322741 DOI: 10.1016/j.ijscr.2020.03.032] [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: 07/18/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mycotic pseudoaneurysm of the carotid artery is a severe and rare disease. When it ruptures, it can produce severe morbidity and high mortality. It presents clinically as a pulsatile mass, usually diagnosable by computed tomography angiography with definitive confirmation achieved by establishing the presence of the pathogen in the tissue sample. CASE PRESENTATION We present the case of a 68-year-old male patient with a history of total laryngectomy. He presented with painful and pulsatile mass in his neck and, after precise evaluation, a ruptured carotid mycotic pseudoaneurysm was promptly detected and treated. After a surgical intervention and an adequate course of antibiotics, the patient successfully recovered. CONCLUSIONS Mycotic pseudoaneurysms of the extracranial carotid artery are uncommon and should always be surgically treated. Due to the high risk of potential complications, restoration of the arterial flow should be attempted in all occasions. High clinical awareness is imperative when approaching a mycotic pseudoaneurysm due to its wide spectrum of clinical symptoms, and must always be considered when diagnosing tumors of the neck. Despite its rarity, early detection and prompt treatment are critical to minimize the possibility of a fatal outcome.
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Affiliation(s)
- Gabriel Molina
- PGY4 Surgery Resident at Pontificia Universidad del Ecuador, Quito, Ecuador
| | - Carolina Mesías
- Head and Neck Surgery, Universidad Autónoma de México, Mexico
| | - Juan Calispa
- Hospital de Especialidades Fuerzas Armadas, Quito, Ecuador
| | - Kevin Arroyo
- Universidad Central del Ecuador, Department of Surgery, Quito, Ecuador
| | - Katherine Jaramillo
- Pontificia Universidad Católica del Ecuador, Department of Surgery, Quito, Ecuador
| | | | | | - Patricio Gálvez
- Docente Carrera de Medicina, Facultad de Ciencias Médicas, Universidad de las Américas, Quito, Ecuador.
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