51
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Kondo T, Hirota M, Kondo S, Hoshino J, Yoshida M, Isomura T. Post-Thoracic Endovascular Aortic Repair Complicated with Mycotic Aneurysm Rupture, Repaired by Redo Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2016; 33:228.e1-4. [PMID: 26965815 DOI: 10.1016/j.avsg.2015.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/26/2015] [Accepted: 10/09/2015] [Indexed: 11/18/2022]
Abstract
Mycotic aneurysms although rare can be devastating. We encountered a dialysis patient with rapidly expanding distal aortic arch aneurysm who underwent axilloaxillary bypass and thoracic endovascular aortic repair (TEVAR). Three months later, he suffered mycotic aneurysm rupture for which redo TEVAR was performed. Antibiotic therapy was discontinued 16 weeks after the second operation, and renal transplantation was performed 6 months later. Dialysis was discontinued in the patient without infection recurrence.
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52
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Blanco Amil CL, Vidal Rey J, López Arquillo I, Pérez Rodríguez MT, Encisa de Sá JM. Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection. Ann Vasc Surg 2016; 33:227.e13-20. [PMID: 26965799 DOI: 10.1016/j.avsg.2015.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/19/2015] [Accepted: 11/21/2015] [Indexed: 11/19/2022]
Abstract
Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.
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53
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Fukuchi T, Kawasaki S, Hayashi H, Koreeda D, Ashikawa T. Mycotic Aneurysm Caused by Bacteroides fragilis in an Elderly Immunosuppressed Patient. Intern Med 2016; 55:3535-3538. [PMID: 27904124 PMCID: PMC5216158 DOI: 10.2169/internalmedicine.55.7090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An 82-year-old Japanese man, who presented with a fever and abdominal pain, was admitted to our hospital. According to enhanced computed tomography images, the probable diagnosis was abdominal aortic mycotic aneurysm. Eight sets of blood cultures obtained from the patient were negative. Despite administering treatment with vancomycin and ceftriaxone, the aneurysm progressively enlarged. He underwent open debridement surgery and in situ replacement because of an aneurysmal rupture. Bacteroides fragilis was isolated from the tissue culture of the aortic wall. Metronidazole was administered and discontinued without any infection relapse. When faced with similar cases, rare pathogens should thus be considered as possible causes of mycotic aneurysms.
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54
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Lin CH, Tsai HW, Hwang JI, Tsan YT, Hu SY. Brachial artery mycotic aneurysm and splenic infarction associated with infective endocarditis. QJM 2015; 108:981-2. [PMID: 26186921 PMCID: PMC4658470 DOI: 10.1093/qjmed/hcv127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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55
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Broos PPHL, Hagenaars JCJP, Kampschreur LM, Wever PC, Bleeker-Rovers CP, Koning OHJ, Teijink JAW, Wegdam-Blans MCA. Vascular complications and surgical interventions after world's largest Q fever outbreak. J Vasc Surg 2015; 62:1273-80. [PMID: 26365665 DOI: 10.1016/j.jvs.2015.06.217] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Since chronic Q fever often develops insidiously, and symptoms are not always recognized at an early stage, complications are often present at the time of diagnosis. We describe complications associated with vascular chronic Q fever as found in the largest cohort of chronic Q fever patients so far. METHODS Patients with proven or probable chronic Q fever with a focus of infection in an aortic aneurysm or vascular graft were included in this study, using the Dutch national chronic Q fever database. RESULTS A total of 122 patients were diagnosed with vascular chronic Q fever between April 2008 and June 2012. The infection affected a vascular graft in 62 patients (50.8%) and an aneurysm in 53 patients (43.7%). Seven patients (5.7%) had a different vascular focus. Thirty-six patients (29.5%) presented with acute complications, and 35 of these patients (97.2%) underwent surgery. Following diagnosis and start of antibiotic treatment, 26 patients (21.3%) presented with a variety of complications requiring surgical treatment during a mean follow-up of 14.1 ± 9.1 months. The overall mortality rate was 23.7%. Among these patients, mortality was associated with chronic Q fever in 18 patients (62.1%). CONCLUSIONS The management of vascular infections with C. burnetii tends to be complicated. Diagnosis is often difficult due to asymptomatic presentation. Patients undergo challenging surgical corrections and long-term antibiotic treatment. Complication rates and mortality are high in this patient cohort.
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56
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Yong MS, Saxena P, Killu AM, Coffey S, Burkhart HM, Wan SH, Malouf JF. The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography. Tex Heart Inst J 2015; 42:372-6. [PMID: 26413022 DOI: 10.14503/thij-14-4375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis. A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Anti-Bacterial Agents/therapeutic use
- Aortic Valve/abnormalities
- Aortic Valve/diagnostic imaging
- Aortic Valve/microbiology
- Aortic Valve/surgery
- Bicuspid Aortic Valve Disease
- Echocardiography, Three-Dimensional
- Echocardiography, Transesophageal
- Endocarditis, Bacterial/diagnostic imaging
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/surgery
- Heart Valve Diseases/complications
- Heart Valve Diseases/diagnostic imaging
- Heart Valve Diseases/surgery
- Heart Valve Prosthesis/adverse effects
- Heart Valve Prosthesis Implantation/adverse effects
- Heart Valve Prosthesis Implantation/instrumentation
- Humans
- Male
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/microbiology
- Mitral Valve/surgery
- Predictive Value of Tests
- Preoperative Care
- Reoperation
- Substance Abuse, Intravenous/complications
- Treatment Outcome
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57
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Boieru R, Georg Y, Ramlugun D, Martinot M, Camin A, Matysiak L, Kretz B. Endovascular Treatment of Infected Brachial Pseudoaneurysm in an Intravenous Drug Abuser: A Case Report. Ann Vasc Surg 2015; 29:1449.e13-6. [PMID: 26142880 DOI: 10.1016/j.avsg.2015.04.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/25/2015] [Accepted: 04/06/2015] [Indexed: 11/19/2022]
Abstract
We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, the patient was discharged with good short results but stent need to be removed at 6 months for thrombosis and partial exposure through the wound.
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58
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Girometti N, Giannella M, Brocchi S, Badia L, Calza L, Viale P. Salmonella paratyphi B mycotic aneurysm of the abdominal aorta in an HIV-infected patient: a case report. LE INFEZIONI IN MEDICINA 2015; 23:174-177. [PMID: 26110299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An HIV-infected 49-year-old man was admitted with polyuria, fever, chills and a dull left lumbar pain. Laboratory tests showed increased C-reactive protein while urine analysis and abdomen ultrasound scan were negative. Blood cultures revealed a Salmonella paratyphi B, identified through MALDI-TOF mass spectrometry. Targeted antibiotic therapy with intravenous piperacillin/tazobactam was started and a multi-phase contrast-enhanced abdomen CT-scan was performed at 24 hours from admission showing a saccular aneurysm of the abdominal aorta with a 1 cm penetrating aortic ulcer on posterior wall. The patient underwent emergency vascular surgery at 34 hours from admission for debridement and homo-graft placement of sub-renal aorta, and surgical samples were sent for microbiological analysis. Unfortunately, the patient died on post-surgical day 7 after haemorrhagic shock due to laceration of his graft. Salmonella paratyphi infection can be responsible for sepsis in severely immunosuppressed patients with poorly controlled HIV, requiring careful work-up for cardiovascular involvement.
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59
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Heldenberg E, Rabin I, Peer A, Karplus R, Bass A. A Creative Approach to Mycotic Abdominal Aortic Aneurysm Secondary to Coxiella burnetii Infection. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2015; 17:385-386. [PMID: 26234001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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60
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Feldman LF, Hersh Z, Birk E, Amir G, Wertheimer G. [MYCOTIC ANEURYSM OF THE ASCENDING AORTA AND CEREBRAL INFARCTS IN A 17-MONTH OLD CHILD WITH KINGELLA KINGAE ENDOCARDITIS]. HAREFUAH 2015; 154:369-405. [PMID: 26281080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Endocarditis is an uncommon presentation of Kingella kingae infection in children. A previously healthy 17 month old child was referred to our emergency department for evaluation of fever lasting eleven days, aphthous stomatitis and a new systolic murmur. Within a few hours of admission, antibiotic therapy was initiated for a presumptive diagnosis of bacteremia and within 24 hours after admission, gram negative coccobacilli were growing in the blood culture. In addition, echocardiography demonstrated a mycotic aneurysm of the ascending aorta with a mobile vegetation. The presumptive diagnosis of Kingella kingae endocarditis was made. Further evaluation by MRI revealed frontal and occipital cerebral infarcts. Due to the presence of presumed septic emboli in conjunction with progressive left ventricular dysfunction, the child was urgently taken to the operating room where aggressive debridement of the infected tissue was performed and the aortic aneurysm was repaired. The patient had an uneventful post-operative course. This case emphasizes the need for a high index of suspicion when evaluating children with community acquired infection. In addition, it also demonstrates the importance of early diagnosis and appropriate treatment of K. kingae endocarditis.
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61
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Kahlberg A, Melissano G, Tshomba Y, Leopardi M, Chiesa R. Strategies to treat thoracic aortitis and infected aortic grafts. THE JOURNAL OF CARDIOVASCULAR SURGERY 2015; 56:269-280. [PMID: 25608572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Infectious thoracic aortitis is a rare disease, especially since the incidence of syphilis and tuberculosis has dropped in western countries. However, the risk to develop an infectious aortitis and subsequent mycotic aneurysm formation is still present, particularly in case of associated endocarditis, sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently. Several etiopathogenetic factors may play a role in thoracic aortic and prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. Also, fistulization of the esophagus or the bronchial tree is commonly associated with these diseases, and it represents a critical event requiring a multidisciplinary management. Knowledge on underlying micro-organisms, antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of infectious diseases involving the thoracic aorta. When the diagnosis of a mycotic aneurysm or a prosthetic graft infection is established, treatment is demanding, often including a number of surgical options. Patients are usually severely compromised by sepsis, and in most cases they are considered unfit for surgery for general clinical conditions or local concerns. Thus, results of different therapeutic strategies for infectious diseases of the thoracic aorta are still burdened with very high morbidity and mortality. In this manuscript, we review the literature regarding the main issues related to thoracic infectious aortitis and aortic graft infections, and we report our personal series of patients surgically treated at our institution for these conditions from 1993 to 2014.
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62
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63
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Ikeuchi M, Ando M, Hisano K, Nakamura R, Urabe Y, Uchida T. [Stent graft for rapidly growing thoracic mycotic aneurysm in a patient with advanced lung cancer]. FUKUOKA IGAKU ZASSHI = HUKUOKA ACTA MEDICA 2015; 106:41-46. [PMID: 26021128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a compromised patient with mycotic aneurysm, who was successfully treated by urgent placement of a stent graft. A man in his seventies was admitted to our hospital with relapsing high fever and back pain during chemotherapy for advanced squamous cell carcinoma of the lung. Contrast CT demonstrated a saccular aneurysm of the thoracic aorta and left pleural effusion. Blood cultures were positive for Escherichia coli producing extended spectrum beta-lactamase (ESBL). Therefore, thoracic mycotic aneurysm was diagnosed. Because of rapid growth on consecutive examinations, absolute bed rest was required. Therefore, we performed antibiotic therapy combined with stent graft placement, which achieved complete exclusion of the aneurysm. He was discharged in an ambulatory state, and his quality of life remained good at home until just before death from terminal state of the cancer.
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64
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Ito T, Nakamori S, Ota S, Ito M. Ruptured mycotic aneurysm and microbleeds in a patient with infective endocarditis. Intern Med 2015; 54:857-8. [PMID: 25832957 DOI: 10.2169/internalmedicine.54.3665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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65
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Hung YM, Chang YT, Wang JS, Wang PYP, Wann SR. A rare but potentially lethal case of tuberculous aortic aneurysm presenting with repeated attacks of abdominal pain. Intern Med 2015; 54:1145-8. [PMID: 25948366 DOI: 10.2169/internalmedicine.54.3620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.
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MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/microbiology
- Abdominal Pain/therapy
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Antibiotics, Antitubercular/administration & dosage
- Aorta, Abdominal/microbiology
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/therapy
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/complications
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/microbiology
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66
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Karkos CD, Kalogirou TE, Giagtzidis IT, Papazoglou KO. Ruptured mycotic common femoral artery pseudoaneurysm: fatal pulmonary embolism after emergency stent-grafting in a drug abuser. Tex Heart Inst J 2014; 41:634-7. [PMID: 25593530 DOI: 10.14503/thij-13-3882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The rupture of a mycotic femoral artery pseudoaneurysm in an intravenous drug abuser is a limb- and life-threatening condition that necessitates emergency intervention. Emergency stent-grafting appears to be a viable, minimally invasive alternative, or a bridge, to subsequent open surgery. Caution is required in cases of suspected concomitant deep vein thrombosis in order to minimize the possibility of massive pulmonary embolism during stent-grafting, perhaps by omitting stent-graft postdilation or by inserting an inferior vena cava filter first. We describe the emergency endovascular management, in a 60-year-old male intravenous drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, which was complicated by a fatal pulmonary embolism.
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MESH Headings
- Aneurysm, False/diagnosis
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/microbiology
- Aneurysm, Ruptured/surgery
- Blood Vessel Prosthesis Implantation/adverse effects
- Drug Users
- Emergencies
- Endovascular Procedures/adverse effects
- Fatal Outcome
- Femoral Artery/diagnostic imaging
- Femoral Artery/microbiology
- Femoral Artery/surgery
- Humans
- Male
- Middle Aged
- Pulmonary Embolism/diagnosis
- Pulmonary Embolism/etiology
- Radiography, Interventional
- Substance Abuse, Intravenous/complications
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67
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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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68
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Matsuda B, Hoo A, Teerasukjinda O, Chung H, Tokeshi J. Group B streptococcal (GBS) bacteremia with mycotic thoracic aortic aneurysm and suppurative pericardial effusion. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2014; 73:25-28. [PMID: 25285253 PMCID: PMC4175936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mycotic aortic aneurysm associated with suppurative pericardial effusion is a rare and serious clinical phenomenon that is linked with significant morbidity and mortality. We report a case of a 78-year-old man who presented with purulent pericardial effusion with tamponade physiology in association with a progressively enlarging, transverse aortic arch, mycotic aneurysm due to group B streptococci. To our knowledge, this is only the second reported case of this nature. Despite advances in the current era of antibiotics and surgical techniques, early diagnosis and aggressive treatment remain sentinel to successful management of the cardiovascular complications of group B streptococcus bacteremia.
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69
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Gabrielli R, Rosati MS, Marcuccio L, Siani A. Mycotic aneurysm of dorsalis pedis artery due to recurrent Candida albicans foot infection. J Vasc Surg 2014; 59:1707-8. [PMID: 24836768 DOI: 10.1016/j.jvs.2013.06.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 04/18/2012] [Accepted: 06/30/2013] [Indexed: 11/19/2022]
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70
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Sachdeva A, Paul B, Bhatia N, Kumar V. Mycotic popliteal artery aneurysm. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2014; 62:413-414. [PMID: 25438487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The name mycotic aneurysm was coined by Osler to describe aneurysms associated with bacterial endocarditis with an appearance of fresh fungal vegetations; however majority of them are caused by bacteria. Mycotic aneurysm (MA) is a rare complication of infective endocarditis (IE), seen in 3-15% of IE patients.
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MESH Headings
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Angiography
- Anti-Bacterial Agents/therapeutic use
- Diagnosis, Differential
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Humans
- Long-Term Care
- Magnetic Resonance Angiography
- Popliteal Artery/microbiology
- Popliteal Artery/surgery
- Sensitivity and Specificity
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Duplex
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71
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Teixeira PG, Thompson E, Wartman S, Woo K. Infective endocarditis associated superior mesenteric artery pseudoaneurysm. Ann Vasc Surg 2014; 28:1563.e1-5. [PMID: 24704049 DOI: 10.1016/j.avsg.2014.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 03/16/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since William Osler first described mycotic aneurysms in the setting of endocarditis in 1885, few pseudoaneurysms (PAs) of the superior mesenteric artery (SMA) have been reported in the literature. We report 2 cases of SMA PA related to infective endocarditis that were managed with open surgery. RESULTS Here we report 2 cases of SMA PAs treated with different surgical techniques. A 59-year-old male with a history of intravenous drug use presented with abdominal pain and was found to have Streptococcus viridans endocarditis and an SMA PA. A laparotomy was performed, and proximal and distal control of the SMA PA was obtained. After ensuring that Doppler signals were still present in the distal mesentery and the entirety of the bowel was viable, the SMA was ligated proximal and distal to the PA. The patient recovered uneventfully. The second case is a 35-year-old female who presented with abdominal pain and was found to have Streptococcos gordonii endocarditis and an SMA PA for which the patient was initially observed. After several weeks, the patient's condition deteriorated and the patient underwent open ligation of the SMA, proximal and distal to the PA, with a bypass from the infrarenal abdominal aorta to a distal unnamed SMA branch and resection of 3 ft of ischemic small bowel. The patient continued to have recurrent bowel ischemia over the next several weeks and ultimately died. CONCLUSIONS SMA PAs associated with infective endocarditis are rare, but carry a high risk of rupture and associated morbidity and mortality. Delay in surgical management may increase this risk.
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MESH Headings
- Adult
- Aneurysm, False/diagnosis
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Fatal Outcome
- Female
- Humans
- Ligation
- Male
- Mesenteric Artery, Superior/diagnostic imaging
- Mesenteric Artery, Superior/microbiology
- Mesenteric Artery, Superior/surgery
- Mesenteric Ischemia/microbiology
- Middle Aged
- Streptococcal Infections/complications
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcus gordonii/isolation & purification
- Substance Abuse, Intravenous/complications
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Grafting
- Viridans Streptococci/isolation & purification
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72
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González I, Sarriá C, López J, Vilacosta I, San Román A, Olmos C, Sáez C, Revilla A, Hernández M, Caniego JL, Fernández C. Symptomatic peripheral mycotic aneurysms due to infective endocarditis: a contemporary profile. Medicine (Baltimore) 2014; 93:42-52. [PMID: 24378742 PMCID: PMC4616324 DOI: 10.1097/md.0000000000000014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Peripheral mycotic aneurysms (PMAs) are a relatively rare but serious complication of infective endocarditis (IE). We conducted the current study to describe and compare the current epidemiologic, microbiologic, clinical, diagnostic, therapeutic, and prognostic characteristics of patients with symptomatic PMAs (SPMAs). A descriptive, comparative, retrospective observational study was performed in 3 tertiary hospitals, which are reference centers for cardiac surgery. From 922 definite IE episodes collected from 1996 to 2011, 18 patients (1.9%) had SPMAs. Because all SPMAs developed in left-sided IE, we performed a comparative study between 719 episodes of left-sided IE without SPMAs and 18 episodes with SPMAs. We found a higher frequency of intravenous drug abuse, native valve IE, intracranial bleeding, septic emboli, multiple embolisms, and IE diagnostic delay >30 days in patients with SPMAs than in patients without SPMAs. The causal microorganisms were gram-positive cocci (n =10), gram-negative bacilli (n = 2), gram-positive bacilli (n = 3), Bartonella henselae (n = 1), Candida albicans (n = 1), and negative culture (n = 1). The median IE diagnosis delay was 15 days (interquartile range [IQR], 13-33 d) in the case of high-virulence microorganisms versus 45 days (IQR, 30-240 d) in the case of low- to medium-virulence microorganisms. Twelve SPMAs were intracranial and 6 were extracranial. In 10 cases (8 intracranial and 2 extracranial), SPMAs were the initial presentation of IE; the remaining cases developed symptoms during or after finishing parenteral antibiotic treatment. The initial diagnosis of intracranial SPMAs was made by computed tomography (CT) or magnetic resonance imaging in 6 unruptured aneurysms and by angiography in 6 ruptured aneurysms. The initial test in extracranial SPMAs was Doppler ultrasonography in limbs, CT in liver, and coronary angiography in heart. Four (3 intracranial, 1 extracranial) of 7 (6 intracranial, 1 extracranial) patients treated only with antibiotics died. Surgical resection was performed in 7 (3 intracranial, 4 extracranial) and endovascular repair in 4 (3 intracranial, 1 extracranial) patients; all of them survived. In conclusion, we found that SPMAs were a rare complication of IE that developed only in left-sided IE, and especially in native valves. Intracranial hemorrhage, embolism, multiple embolisms, and diagnostic delay of IE were more common in patients with SPMAs. The microbiologic profile was diverse, but microorganisms of low-medium virulence were predominant, and had a greater delayed diagnosis of IE than those caused by microorganisms of high virulence. SPMAs were often the initial presentation of IE. The most common location of SPMAs was intracranial. Noninvasive radiologic imaging techniques were the initial imaging test in intracranial unruptured SPMAs and in most extracranial SPMAs. Surgical and endovascular treatments were safe and effective. Endovascular treatment could be the first line of treatment in selected cases. Mortality was high in those cases treated only with antibiotics.
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73
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Wheeler HK, Quiroga E, Kohler TR, Tang GL. Mycotic aortic aneurysm caused by haemophilus influenzae group F. Ann Vasc Surg 2013; 27:353.e13-6. [PMID: 23498319 DOI: 10.1016/j.avsg.2012.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/02/2012] [Accepted: 05/07/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Haemophilus influenzae is a rare cause of mycotic aortic aneurysm. We present a case of H. influenzae mycotic aortic aneurysm, which was complicated by prior endovascular stent-graft placement at another facility. METHODS A 58 year-old man was treated by endograft placement for a presumed penetrating aortic ulcer after having symptoms of abdominal pain and malaise for one month. He presented to our institution 11 days after endograft placement with septic physiology. Repeat computed tomography angiogram demonstrated an inflammatory mass around the distal aorta and right common iliac artery, which had an associated contained rupture. RESULTS The patient was treated using intravenous antibiotics, axillo-bifemoral bypass followed by endograft explantation and aortic and iliac ligation. Intraoperative cultures grew Haemophilus influenzae, serotype f. CONCLUSIONS Aortic endografts have been successfully used for treatment of selected mycotic aneurysms, generally after adequate treatment of the primary infection with intravenous antibiotics. This case demonstrates the unfavorable natural history of endograft placement in an unsuspected mycotic aneurysm. A high index of suspicion for possible aortic infection should be maintained for patients with systemic symptoms and unusual aortic pathology prior to choosing endovascular repair.
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74
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Tomek M, Cheshire NJW, Rudarakanchana N, Samarasinghe D, Bicknell CD. Salmonella mycotic thoracoabdominal aortic aneurysm associated with chronic lymphocytic leukemia. Ann Vasc Surg 2013; 27:1186.e17-21. [PMID: 23981545 DOI: 10.1016/j.avsg.2012.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/05/2012] [Accepted: 11/16/2012] [Indexed: 11/18/2022]
Abstract
Non-typhoidal Salmonella infections typically cause self-limiting gastroenteritis. However, extraintestinal focal infections, including mycotic aneurysms of the aorta, can also occur. We present the case of a 71-year-old man with chronic lymphocytic leukemia (CLL) and a large type V thoracoabdominal mycotic aneurysm infected with Salmonella enteritidis, complicated by thoracolumbar spondylodiscitis, paravertebral collections, and epidural abscess. This is the first report of Salmonella aortitis in the setting of CLL, and the unusual extent of local infective invasion seen here with Salmonella enteritidis infection raises a suspicion of CLL-related immunosuppression as a direct predisposing factor. This case illustrates the need to consider the possibility of an immune defect, even in CLL patients with normal leukocyte counts. The underlying mechanisms are unclear, but are likely to involve defects in cell-mediated immunity, thought to be of particular importance in invasive infections with intracellular pathogens such as Salmonella spp.
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MESH Headings
- Aged
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/immunology
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/immunology
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/therapy
- Aortitis/diagnosis
- Aortitis/immunology
- Aortitis/microbiology
- Aortitis/therapy
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Debridement
- Discitis/microbiology
- Epidural Abscess/microbiology
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Magnetic Resonance Imaging
- Male
- Risk Factors
- Salmonella Infections/diagnosis
- Salmonella Infections/immunology
- Salmonella Infections/microbiology
- Salmonella Infections/therapy
- Salmonella enteritidis/isolation & purification
- Tomography, X-Ray Computed
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75
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Spiliopoulos S, Mani K, Sabharwal T, Krokidis M, Gkoutzios P. First application of the ‘lasso technique’ on an endograft with suprarenal fixation stent. Vascular 2013; 21:177-81. [PMID: 23508386 DOI: 10.1177/1708538113478733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report the use of the ‘lasso technique’ for the preservation of bilateral renal artery patency, following the intraoperative proximal migration of an aortic endograft with suprarenal bare metal fixation and anchoring barbs, due to device delivery failure.During an emergency endovascular repair of a ruptured mycotic abdominal aortic aneurysm using the Zenith Flex device, the main body of the graft migrated proximally to cover both renal arteries. Attempts to pull down the graft using balloons were not effective.Finally, the ‘lasso technique’ using a guidewire over the aortic bifurcation was employed and successfully adjusted the graft below the level of the renal arteries. No procedure-related complications were noted. The endovascular repair was used as a bridging procedure and two months following the primary endovascular procedure, open surgical repair of the infected aneurysm with excision of the stent graft was performed. The patient is alive after eight months follow-up.
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76
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Cox SG, Naidoo NG, Wood RJ, Clark L, Kilborn T. Tuberculous iliac artery aneurysm in a pediatric patient. J Vasc Surg 2012; 57:834-6. [PMID: 23265583 DOI: 10.1016/j.jvs.2012.08.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 11/19/2022]
Abstract
Vascular complications of tuberculous infections are rare and occur even less frequently in the pediatric population. Tuberculous pseudoaneurysms can occur either as a result of contiguous spread from a neighboring focus-invariably infected lymph nodes-or by hematogenous spread and seeding of acid-fast bacilli that lodge in the adventitia or media via the vasa vasorum. We report a case of turberculous right common iliac artery pseudoaneurysm in a 12-year-old and review the relevant literature.
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77
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Salvado C, Mekinian A, Rouvier P, Poignard P, Pham I, Fain O. Rapidly progressive crescentic glomerulonephritis and aneurism with antineutrophil cytoplasmic antibody: Bartonella henselae endocarditis. Presse Med 2012; 42:1060-1. [PMID: 23079393 DOI: 10.1016/j.lpm.2012.07.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 07/28/2012] [Accepted: 07/31/2012] [Indexed: 11/28/2022] Open
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78
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Redondo Orts M, Serrano Martínez JL, Navarrete Navarrete N, Sabio Sánchez JM. [Mycotic pseudoaneurysm produced by Salmonella enteritidis in a patient with fever of unknown origin]. Med Intensiva 2012; 37:365-6. [PMID: 23044283 DOI: 10.1016/j.medin.2012.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 08/23/2012] [Accepted: 08/24/2012] [Indexed: 11/16/2022]
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79
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Looi JL, Cheung L, Lee APW. Salmonella mycotic aneurysm: a rare cause of fever and back pain in elderly. Int J Cardiovasc Imaging 2012; 29:529-31. [PMID: 22918572 DOI: 10.1007/s10554-012-0115-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 08/13/2012] [Indexed: 11/25/2022]
Abstract
An 85-year-old man with history of hypertension presented with fever, cough and abdominal pain. Unfortunately fever and leukocytosis persisted despite treatment. Blood cultures obtained on admission grew Salmonella enteritidis. Subsequently he developed increasing back pain and transoesophageal echocardiography (TOE) was performed, demonstrating a complex ulcer at the aortic arch with multiple small mobile strandlike densities suggestive of vegetation. Contrast thoracic CT scan confirmed an ulcerated atherosclerotic plaque which progressively increasing in size over 3 months despite antibiotics. Therefore, a stent was deployed in view of high risk of perforation and he was placed on prolonged antibiotics. Post-stenting CT scan a few months later showed a patent stent with the aneurysm remained stable in size. Cardiovascular infections develop in approximately 25 % of patients with Salmonella bacteremia. Most patients with Salmonella aortitis have preexisting atherosclerosis at the site of the subsequently infected aneurysm. The diagnosis of S. aortitis can be challenging, because the clinical course may be indolent and the symptoms are nonspecific. A high index of suspicion is required to make the diagnosis of S. aortitis, especially in patients with Salmonella bacteraemia, fever, back pain and/or abdominal pain. This case highlights the usefulness of TOE in the evaluation of diseases involving the thoracic aorta, leading to a successful intervention.
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80
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Veiga C, Gómez JJ, Aguilera L. [Ruptured cerebral aneurysm after a Candida parapsilosis prosthetic valve endocarditis]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:521-2. [PMID: 22749302 DOI: 10.1016/j.redar.2012.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 05/04/2012] [Indexed: 11/15/2022]
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81
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Nakayama Y, Yamaki F, Matsumura Y. Endovascular aneurysm repair of saccular descending thoracic pseudoaneurysm possibly associated with tuberculosis. Gen Thorac Cardiovasc Surg 2012; 60:501-3. [PMID: 22700454 DOI: 10.1007/s11748-012-0038-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/05/2011] [Indexed: 11/26/2022]
Abstract
In 2010, an 84-year-old man underwent thoracic endovascular aneurysm repair (TEVAR) for the saccular descending thoracic pseudoaneurysm (DTAA), which was adherent to the pulmonary lobe and thoracic vertebrae. Past medical history comprised twice anti-tuberculous medications for pulmonary tuberculosis and tuberculous vertebral osteomyelitis. The dilated aorta was detected at the time of medication for tuberculous vertebral osteomyelitis 24 years ago. However, he was not indicated for the operation, and he was lost to follow-up until now. The association of tuberculosis bacilli was suspected through clinical course as an origin of DTAA, although the histopathological examination was not performed because of invasion. TEVAR was performed considering: (1) no preoperative ongoing inflammation, (2) no evidence of tuberculosis recurrence, and (3) risk factors, such as pulmonary impairments and high age. Several months have been passed since the operation, and the patient remains well without perioperative anti-tuberculous medications.
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MESH Headings
- Aged, 80 and over
- Aneurysm, False/diagnosis
- Aneurysm, False/drug therapy
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/drug therapy
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Antitubercular Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/drug therapy
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Endovascular Procedures
- Humans
- Male
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/drug therapy
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Cardiovascular/surgery
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82
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Da Gama AD, Evangelista A, Ministro A, Manuel V, Silvestre L, Tiago J. [Large infectious thoracoabdominal aortic aneurysm in a chronic contained rupture, treated successfully using the "simplified technique"]. REVISTA PORTUGUESA DE CIRURGIA CARDIO-TORACICA E VASCULAR : ORGAO OFICIAL DA SOCIEDADE PORTUGUESA DE CIRURGIA CARDIO-TORACICA E VASCULAR 2012; 19:87-94. [PMID: 23814778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Indexed: 06/02/2023]
Abstract
The clinical case of a 72-years old male is reported, admitted into a Medical Department through the Emergency Service, with a clinical picture of heavy lumbar pain, with walking compromise and acute urinary retention, lasting for several hours. Laboratory analysis revealed a marked elevation of acute inflammatory parameters and a renal failure, expressed by 108 mg/dl of urea and 4.4 mg/dl of creatinine. The patient was admitted with the provisional diagnosis of acute prostatitis, pos-renal acute renal insufficiency and dorso-lumbar pathology of unknown etiology. Three consecutive and subsequent hemocultures allowed the isolation of a Streptococcus pneumonae strain and a CT dorso lumbar spine evaluation disclosed a D11 to D12 spondylodiscitis, with a partial destruction of the vertebral bodies and an extensive throracoabdominal aortic aneurysm adjacent to those vertebrae, with some characteristic features of an infectious aneurysm. Simultaneously, an hemothorax on the left chest was noticed, consequence of a chronic contained rupture of the aneurysm. Following an intensive and specific antibiotic therapy and with an almost completed recovery of the renal function, he underwent surgical management, consisting in the evacuation and drainage of the hemothorax, followed by resection of the aneurysm and extensive tissular debridmente, culminating in the vascular reconstruction utilizing the "simplified technique", introduced in 1984 by A. Dinis da Gama for the surgical management of thoracoabdominal aortic aneurysms. The patiente tolerated the procedure well, with no intercorrences or complications and the post operative course was unventfull. One month later, a CT-angio control disclosed the revascularization procedure working in excellent condition. Finally, an orthopedic artrodhesis of the injuried vertebrae was performed, allowing an easy and pain-free walking and he was discharged on day 60, under antibiotic treatment. The main features of this clinical case are emphasized and discussed, namely those aspects related to its pathogenesis, clinical presentation, diagnosis and surgical management.
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83
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Abstract
Mycotic aneurysms of the common femoral artery are rare and usually occur in intravenous drug abusers who use the femoral vessels for injection. We herein describe a case of mycotic aneurysm of the common femoral artery caused by methicillin-sensitive Staphylococcus aureus seeding of an atherosclerotic plaque in which the bacteria possibly originated from psoriatic skin lesions. A 67-year-old Caucasian man was admitted to the hospital after experiencing chest pain for two days. He was known to have psoriasis and coronary artery disease with a history of coronary artery bypass grafting surgery three years earlier. He was found to have methicillin-sensitive Staphylococcus aureus bacteremia and later developed a mycotic aneurysm of the femoral artery opposite to the site of catheterization access. Mycotic aneurysms are rare clinical conditions associated with significant morbidity and mortality. In patients with psoriasis, a high prevalence of Staphylococcus aureus colonization of the skin makes possible bacterial seeding of existing atherosclerotic plaques. Therefore, the risk of mycotic pseudoaneurysm formation in these patients should be considered.
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84
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Cherniavskiĭ AM, Éfendiev VU, Ruzmatov TM, Lomivorotov VV, Kornilov IA, Deriagin MN, Efanova OS. [Treatment of a patient with a ruptured infectious aneurysm of the aortic arch]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2012; 18:120-124. [PMID: 23324641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Described in the article is a clinical case report concerning surgical treatment of a 65-year-old male patient presenting with a ruptured infectious aortic arch aneurysm. He was subjected to an operation consisting in prosthetic repair of the ascending portion of the aorta and aortic arch with a homograft under conditions of artificial circulation, deep hypothermia, and antegrade cerebral perfusion.
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MESH Headings
- Aged
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/physiopathology
- Aneurysm, Infected/surgery
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/surgery
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/surgery
- Aortic Rupture/diagnosis
- Aortic Rupture/physiopathology
- Aortic Rupture/surgery
- Aortography/methods
- Blood Vessel Prosthesis
- Clostridium tertium/isolation & purification
- Echocardiography/methods
- Extracorporeal Circulation/methods
- Humans
- Hypothermia, Induced/methods
- Male
- Pericardial Effusion
- Tomography, X-Ray Computed/methods
- Treatment Outcome
- Vascular Grafting/instrumentation
- Vascular Grafting/methods
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85
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Mukherjee JT, Nautiyal A, Labib SB. Mycotic aneurysms of the ascending aorta in the absence of endocarditis. Tex Heart Inst J 2012; 39:692-695. [PMID: 23109770 PMCID: PMC3461658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Mycotic aneurysm formation is a rare and potentially fatal sequela of bacteremia. We present the cases of 2 octogenarians who had surgically confirmed mycotic aneurysms that involved the ascending aorta, with contained rupture (pseudoaneurysm). Neither patient had evidence of valvular endocarditis. Patient 1, an 82-year-old man, had streptococcal bacteremia. Imaging confirmed a mycotic aneurysm of the ascending aorta, and resection was successful. Patient 2, an 83-year-old woman, had recurrent staphylococcal bacteremia and progressive widening of the mediastinum, and imaging revealed a mycotic pseudoaneurysm. She underwent surgical repair with use of a bovine pericardial patch, but she died 2 weeks later because of patch dehiscence.We did not initially suspect mycotic aneurysm in either patient. Despite the availability of accurate, noninvasive imaging techniques, strong clinical suspicion is required for the early diagnosis of mycotic aneurysm.
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86
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Correia E, Almeida J, Madureira AJ, Monteiro V. [Mycotic aneurysm of the left ventricular free wall complicating aortic valve endocarditis]. Rev Port Cardiol 2011; 31:31-4. [PMID: 22153312 DOI: 10.1016/j.repc.2011.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 34-year-old man with aortic valve infective endocarditis caused by methicillin-resistant Staphylococcus aureus, complicated by an aortic annular abscess. A 23-mm St. Jude HP aortic mechanical prosthesis was implanted. The pre-discharge echocardiogram revealed a mycotic aneurysm of the basal posteroinferior wall, confirmed by cardiac magnetic resonance imaging, and it was decided to reintervene. The aneurysm was closed with a patch and the mitral valve had to be replaced. Although a small leak from the aneurysm patch persisted on the pre-discharge transthoracic echocardiogram, there was no trace of the aneurysm at nine-month re-evaluation. This case illustrates a rare complication of aortic valve endocarditis and shows the evolution of the mycotic aneurysm after closure via a transmitral approach.
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87
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Sharma P, Cohen JK, Lockhart SR, Hurst SF, Drew CP. Ruptured mycotic aortic aneurysm in a sooty mangabey (Cercocebus atys). Comp Med 2011; 61:532-7. [PMID: 22330581 PMCID: PMC3236696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 06/21/2011] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
Mycotic aortic aneurysm is a local, irreversible dilatation of the aorta associated with destruction of the vessel wall by infection and is a grave clinical condition associated with high morbidity and mortality in humans. Rupture of aortic aneurysms can be spontaneous, idiopathic, or due to severe trauma, and the condition has been associated with bacterial and, rarely, fungal infections in humans and animals. Here, we describe a case of ruptured spontaneous aortic aneurysm associated with zygomycetic infection in a 21-y-old female sooty mangabey. The animal did not present with any significant clinical signs before being found dead. At necropsy, she was in good body condition, and the thoracic cavity had a large amount of clotted blood filling the left pleural space and surrounding the lung lobes. Near the aortic arch, the descending thoracic aorta was focally perforated (diameter, approximately 0.15 cm), and clotted blood adhered to the tunica adventitia. The aortic intima had multiple, firm, pale-yellow nodules (diameter, 0.25 to 0.5 cm). Histopathologically, these nodules consisted of severe multifocal pyogranulomatous inflammation intermixed with necrosis, fibrin, and broad, infrequently septate, thin-walled fungal hyphae. Immunohistochemistry revealed fungal hyphae characteristic of Mucormycetes (formerly Zygomycetes), and PCR analysis identified the organism as Basidiobolus spp. Dissemination of the fungus beyond the aorta was not noted. Spontaneous aortic aneurysms have been described in nonhuman primates, but this is the first reported case of a ruptured spontaneous aortic aneurysm associated with entomophthoromycetic infection in a sooty mangabey.
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88
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Marti V, Seixo F, Leta R, Serra A. [Mycotic aortic aneurysm secondary to repeated endocarditis]. Rev Port Cardiol 2011; 30:863-4. [PMID: 22032953 DOI: 10.1016/j.repc.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/26/2011] [Indexed: 11/19/2022] Open
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89
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Abu Bakar A, Ngiu CS, Mohamad Said MS, Periyasamy P. Salmonella related mycotic aneurysm with psoas and paraortic abscess treated conservatively. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011; 40:467-468. [PMID: 22206056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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90
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Tsokos M. Syphilitic aortic aneurysm rupture as cause of sudden death. Forensic Sci Med Pathol 2011; 8:325-6. [PMID: 21811878 DOI: 10.1007/s12024-011-9266-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2011] [Indexed: 11/28/2022]
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91
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Wang Y, Zhang J, Yin MD, Wang SY, Duan ZQ, Xin SJ. Endovascular repair of a tuberculous aneurysm of descending thoracic aorta. Chin Med J (Engl) 2011; 124:2228-2230. [PMID: 21933632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Tuberculous aortic aneurysm (TBAA) is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial, endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication. The outcome was favorable.
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92
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Polat KY, Aydinli B, Keles M, Uyanik A, Ozturk G, Ceviz M, Gundogdu C, Kantarci M. Spontaneous mycotic external iliac artery aneurysm rupture after perforated acute appendicitis in a renal allograft recipient. EXP CLIN TRANSPLANT 2011; 9:211-213. [PMID: 21649572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Acute appendicitis is uncommon after renal transplant. Infection with Candida albicans can produce serious complications by compromising the vascular anastomosis. In such cases, the origin of Candida albicans is often in the gastrointestinal system. Here, we report 2 uncommon complications that occurred in the same patient. A 27-year-old female renal transplant patient with appendicitis presented to our institution with acute graft failure. The patient was treated with an appendectomy and a transplant nephrectomy. Subsequently, the patient had a mycotic pseudoaneurysm rupture of the external iliac artery secondary to Candida albicans infection that originated possibly in the gastrointestinal system. This complication was further treated with a cross-femoral bypass. The occurrence of these 2 complications together is rare.
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93
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Han DK, Chung C, Walkup MH, Faries PL, Marin ML, Ellozy SH. Endovascular stent-graft repair of a tuberculous mycotic aortic aneurysm. Ann Vasc Surg 2011; 25:699.e13-6. [PMID: 21514110 DOI: 10.1016/j.avsg.2010.12.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 11/05/2010] [Accepted: 12/24/2010] [Indexed: 11/19/2022]
Abstract
Mycobacterium tuberculosis is a rare cause of mycotic aortic aneurysms, which have been classically treated with a combination of antimycobacterial medical therapy and open surgery. Endovascular therapy has been gaining popularity as an alternative to open surgery for mycotic aneurysms. We report a case of a tuberculous mycotic aneurysm of the descending thoracic aorta that was successfully treated with endovascular stent-graft placement with complete resolution of the pseudoaneurysm at 1 year. We also review other cases in the previously published data to identify factors that may affect the outcome of endovascular treatment of tuberculous mycotic aneurysms.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Antitubercular Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/instrumentation
- Endovascular Procedures/instrumentation
- Female
- Humans
- Middle Aged
- Mycobacterium tuberculosis/isolation & purification
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Cardiovascular/surgery
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94
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Matsui S, Hatta T. Mycotic abdominal aortic aneurysm in a dialysis patient with catheter-related methicillin-resistant Staphylococcus aureus bacteremia. Ther Apher Dial 2011; 15:113-4. [PMID: 21272261 DOI: 10.1111/j.1744-9987.2010.00854.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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95
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Mieno S, Ozawa H, Tanigawa J, Kurisu Y, Katsumata T. A surgical case of excision of infected aneurysm arising from anterior interosseal artery following infectious endocarditis. J Vasc Surg 2011; 53:1104-6. [PMID: 21215573 DOI: 10.1016/j.jvs.2010.10.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 10/14/2010] [Accepted: 10/21/2010] [Indexed: 11/17/2022]
Abstract
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.
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96
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Raman SR, Pokala N, Jamil Z. Nontuberculous mycobacterial abdominal aortic aneurysm in a patient with AIDS. Am Surg 2010; 76:1031-3. [PMID: 20836363 DOI: 10.1177/000313481007600949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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97
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Budde RPJ, Kluin J, Symersky P, Chamuleau SAJ, van Herwerden LA, Prokop M. Visualization by 256-slice computed tomography of mycotic aortic root aneurysms in infective endocarditis. THE JOURNAL OF HEART VALVE DISEASE 2010; 19:623-625. [PMID: 21053742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Infective endocarditis (IE) may lead to mycotic aortic root aneurysm formation. Herein is described the preoperative use of ECG-gated contrast-enhanced 256-slice cardiac computed tomography (CT) to optimize surgical planning by visualizing the location and extent of the mycotic aneurysm in two patients with complicated IE. In both cases, CT revealed a large aortic root mycotic aneurysm, accurately determined its location and extent, and also depicted the close relationship of the aneurysm to the major blood vessels. Intraoperative surgical findings corresponded to preoperative CT findings in both cases. Multislice CT is a valuable technique in patients with complicated IE that helps to optimize preoperative surgical planning.
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98
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Masuhara H, Watanabe Y, Fujii T, Shiono N, Hamada S, Hara M, Teramoto C, Yoshihara K, Koyama N. Successful surgical repair of an infectious thoracic aortic pseudoaneurysm accompanied by aortobronchopulmonary fistula and advanced hepatic dysfunction without assisted circulation. Ann Thorac Cardiovasc Surg 2010; 16:35-39. [PMID: 20190708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 02/10/2009] [Indexed: 05/28/2023] Open
Abstract
The patient was a 59-year-old female. Because of massive hemoptysis, she was brought to our emergency center by ambulance. Thoracic computed tomography led to a diagnosis of an infectious thoracic aortic pseudoaneurysm accompanied by an aortobronchopulmonary fistula. Emergency surgery followed. Also noted was an advanced hepatic dysfunction, assessed as Child-Pugh score B, caused by an alcoholic liver disease. A localized affected area made it possible for us to perform an aneurysmectomy using a temporary bypass rather than assisted circulation. A patch plasty using expanded polytetrafluoroethylene completed the procedure. Streptococcus agalactiae (GBS) was detected in a sample obtained during the surgery from an abscess located in the aneurysm. The patient made satisfactory postoperative progress and left the hospital walking unaided on the 36th postoperative day.
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MESH Headings
- Aneurysm, False/complications
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Anti-Bacterial Agents/therapeutic use
- Aortic Aneurysm, Thoracic/complications
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortic Diseases/diagnostic imaging
- Aortic Diseases/microbiology
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Bronchial Fistula/diagnostic imaging
- Bronchial Fistula/microbiology
- Female
- Hemoptysis/etiology
- Humans
- Liver Diseases, Alcoholic/complications
- Liver Diseases, Alcoholic/physiopathology
- Middle Aged
- Severity of Illness Index
- Streptococcus agalactiae/isolation & purification
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Fistula/diagnostic imaging
- Vascular Fistula/microbiology
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99
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Sharma K, Kibria R, Ali S, Rao P. Primary aortoenteric fistula caused by an infected abdominal aortic aneurysm with Mycobacterium avium complex in an HIV patient. Acta Gastroenterol Belg 2010; 73:280-282. [PMID: 20690571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Primary aortoenteric fistula (PAEF) is a rare but complex clinical entity requiring multimodality approach for diagnosis and treatment. We report the first ever case of upper gastrointestinal (UGI) hemorrhage caused by an aortoenteric fistula (AEF) secondary to Mycobacterium avium complex (MAC) in a patient with human immunodeficiency virus (HIV) infection. Esophagogastroduodenoscopy (EGD) showed an ulcer in the distal duodenum and a computed tomography (CT) scan confirmed a contained abdominal aortic aneurysm (AAA) rupture with an aorto-enteric fistula communicating with the third portion of the duodenum. Emergent surgery was undertaken which was lifesaving. A high index of suspicion, early diagnosis and prompt surgical intervention are crucial for survival of patient with PAEF.
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100
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Koo M, Manalili S, Bankowski MJ, Sampath R, Hofstadler SA, Koo J. A "silent culture-negative" abdominal aortic mycotic aneurysm: Rapid detection of Bartonella species using PCR and high-throughput mass spectrometry. HAWAII MEDICAL JOURNAL 2010; 69:68-69. [PMID: 20397506 PMCID: PMC3104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A gram-negative, rod-shaped microorganism was detected in a 69-year-old man suffering from chronic back pain but otherwise exhibiting no signs of infection. The bacterium could not be identified using any routine diagnostic modality. A research use only application utilizing PCR and Mass Spectrometry was performed on nucleic acid extracted from the tissue sample. These studies resulted in the implication of Bartonella quintana as the underlying cause of the infection. B. quintana is not a well-known cause of an abdominal aortic mycotic aneurysm. This article will discuss the B. quintana infection, its diagnosis and treatment, and reinforce the potential of B. quintana as a possible etiology in mycotic aneurysms that show no apparent indications of infection. It will also explore the potential use of polymerase chain reaction detected by electrospray ionization mass spectrometry (PCR/ESI-MS) to help identify B. quintana in a situation where other conventional methods prove non-informative.
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