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Patel H, Patel A, Seth M, Singh A. A case of contained rupture of the superior mesenteric artery with no distal flow causing mesenteric ischemia following double heart valve replacement surgery. Indian J Thorac Cardiovasc Surg 2024; 40:465-468. [PMID: 38919199 PMCID: PMC11194235 DOI: 10.1007/s12055-023-01649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 06/27/2024] Open
Abstract
A visceral artery aneurysm (VAA) is a very rare and lethal vascular anomaly with dramatic consequences. The overall incidence of VAA is 5% of all abdominal artery aneurysms. The involvement of the superior mesenteric artery is even rare (incidence of 3.5-8% of all VAA). The development of superior mesenteric artery pseudoaneurysm following cardiac surgery is scarcely reported in the literature. We report a case of contained rupture of the superior mesenteric artery with no distal flow causing acute mesenteric ischemia (AMI) following double heart valve replacement surgery.
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Affiliation(s)
- Herin Patel
- Department of Cardio Vascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Archit Patel
- Department of Cardio Vascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Megha Seth
- Department of Radiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Aparna Singh
- Department of Pathology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
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2
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Guo H, Stach J, Belletrutti PJ. A Rare Cause of Life-Threatening Upper Gastrointestinal Bleeding. Gastroenterology 2023; 165:1118-1121. [PMID: 37245591 DOI: 10.1053/j.gastro.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Howard Guo
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jesse Stach
- Department of Medicine, Section of Gastroenterology and General Internal Medicine, Medicine Hat Regional Hospital, Medicine Hat, Alberta, Canada
| | - Paul J Belletrutti
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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3
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Zhou X, Pu X, Li Z, Zeng Q, He Y, He Y, Xiang Y, Wu Z, Li D, Lu T, Zhang H, Zhu Q. Endovascular Treatment of Superior Mesenteric Artery Pseudoaneurysm Due to Infective Endocarditis With Stent-Graft. J Endovasc Ther 2023; 30:798-803. [PMID: 37272112 DOI: 10.1177/15266028231176959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report a successful case of pseudoaneurysm of the superior mesenteric artery (SMA) caused by infected endocarditis treated with a covered stent. CASE REPORT A patient was diagnosed with infective endocarditis and 2 months later a proximal SMA pseudoaneurysm was identified on computed tomography. Daptomycin was started on admission and continued for approximately 4 months until the inflammatory markers normalized, and then the SMA pseudoaneurysm was successfully excluded with a stent-graft and antibiotics were continued for 1 year after the procedure. There were no associated complications or recurrences at the 3-year follow-up. CONCLUSION Placing a covered stent with a full course of antibiotics before and after surgery may be a successful alternative to open surgery in the treatment of pseudoaneurysms of the SMA due to infective endocarditis. CLINICAL IMPACT This case report reports a rare case of pseudoaneurysm of the superior mesenteric artery due to infective endocarditis, which was successfully treated with an overlapping stent and confirmed by complete imaging data at a three-year follow-up. This report suggests that endovascular treatment may be an alternative to open surgery in the treatment of pseudoaneurysms of the superior mesenteric artery caused by infective endocarditis.
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Affiliation(s)
- Xiaoxiang Zhou
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xibing Pu
- Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qinglong Zeng
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunjun He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yilang Xiang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongling Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tian Lu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, China
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4
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Al Harthy A, Belot A, Feugier P. Superior Mesenteric Artery Pseudoaneurysm Induced by Accidental Ingestion of a Foreign Body: Case Report. EJVES Vasc Forum 2022; 54:36-39. [PMID: 35146470 PMCID: PMC8819108 DOI: 10.1016/j.ejvsvf.2022.01.002] [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: 05/25/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Superior mesenteric artery (SMA) pseudoaneurysm is a very rare condition, typically associated with trauma, inflammation, and infection, and as a post-operative complication. If left untreated it can lead to serious consequences such as rupture and fatal haemorrhage. Report A 17 year old male presented to the emergency department with a history of intermittent progressive epigastric pain with no preceding significant symptoms of a possible cause. He was initially treated conservatively until the intensity of pain was so severe an abdominal computed tomography (CT) scan was justified. A pseudoaneurysm of the SMA was found. Full inflammatory and immunological workup was unremarkable. Repeat CT scan showed the SMA pseudoaneurysm was larger, mandating surgical intervention; the vascular surgeon suggested an exploratory laparotomy. Intra-operatively, unexpectedly, a wooden foreign body measuring 5.0 × 0.3 × 0.5 cm was seen once the aneurysm sac was opened. The pseudoaneurysm was repaired and the abdomen closed after ascertaining that all other organs were intact. The patient had a simple recovery with no complications and was discharged home. The follow up CT scans were unremarkable. Conclusion Pseudoaneurysm of the SMA in the paediatric age group is an extremely rare and life threatening phenomenon. The clinical presentation may be subtle, leading to delayed diagnosis. Early surgical intervention may be lifesaving and prevent further complications. Pseudoaneurysm due to swallowed foreign body is an extremely rare pathology. Visceral artery pseudoaneurysm are usually silent but potentially fatal. Surgical intervention is mainstay treatment of visceral artery pseudoaneurysm.
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5
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Kochar S, Sharparis Y, Banerjee B, Karasek M, Brennan S. Endovascular Coil Embolization of Superior Mesenteric Artery Branch Pseudoaneurysm. Cureus 2021; 13:e18014. [PMID: 34667689 PMCID: PMC8520142 DOI: 10.7759/cureus.18014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Visceral artery pseudoaneurysms are rare but potentially life-threatening. Among visceral artery pseudoaneurysm (VAPA), the superior mesenteric artery (SMA) pseudoaneurysm is the rarest type. VAPAs are usually related with infection, inflammatory disease, trauma, or arises as a postoperative complication. Early diagnosis and endovascular or surgical intervention are key in lowering the risk of intestinal infarction and death due to potentially fatal hemorrhage. A 49-year-old man presented with cough, shortness of breath, weight loss, and an incidental finding of spontaneous SMA pseudoaneurysm with localized bleed on CT angiography. An urgent endovascular embolization was performed of the pseudoaneurysm, with an adequate outcome and recovery. SMA pseudoaneurysms associated with infective endocarditis are rare but carry a high risk of rupture and related morbidity and mortality. Direct oral anticoagulants like apixaban (Eliquis) have also been reported to cause pseudoaneurysm formation by slow and constant bleeding, which may have contributed here as a cause of pseudoaneurysm along with infective endocarditis, which was diagnosed later after endovascular embolization. The treatment can be either an endovascular, endoscopic, or open surgical approach.
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Affiliation(s)
- Shubra Kochar
- Vascular Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, GBR
| | - Yiannis Sharparis
- Radiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, GBR
| | - Bibek Banerjee
- Vascular Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, GBR
| | - Maciej Karasek
- Radiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, GBR
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6
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Shan DK, Truong H, Tarabey S, Hamilton C, Rahimi SA, Beckerman WE. Giant visceral artery pseudoaneurysm treated with endovascular transradial coil embolization. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:618-621. [PMID: 33163745 PMCID: PMC7599377 DOI: 10.1016/j.jvscit.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022]
Abstract
Visceral artery pseudoaneurysms (PSAs) are relatively rare, and cases associated with distal vasculature of the superior mesenteric artery are largely unreported. Visceral artery PSAs, without intervention, can lead to morbidity or mortality from rupture or mesenteric ischemia. Historically, open aneurysmectomy is the gold standard; however, endovascular modalities have emerged as the first-line treatment in patients who are poor surgical candidates and/or have unfavorable anatomy. Herein, we describe a case of a symptomatic PSA of the distal superior mesenteric artery treated via the transradial approach with endovascular coil embolization, showing successful aneurysmal exclusion and preservation of enteric collateral flow.
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Affiliation(s)
- Deepak K Shan
- Drexel University College of Medicine, Philadelphia, Pa
| | - Huong Truong
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Sally Tarabey
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Charles Hamilton
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Saum A Rahimi
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - William E Beckerman
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
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7
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Sugiyama K, Hosokawa K, Orimoto Y, Ishibashi H. Huge mycotic aneurysm of the superior mesenteric artery complicated with multiple subarachnoid hemorrhage. Asian J Surg 2020; 43:1041-1043. [PMID: 32732063 DOI: 10.1016/j.asjsur.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kayo Sugiyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, Aichi, Japan.
| | - Keijiro Hosokawa
- Department of Vascular Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yuki Orimoto
- Department of Vascular Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hiroyuki Ishibashi
- Department of Vascular Surgery, Aichi Medical University Hospital, Aichi, Japan
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8
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Higashiura W, Takara H, Kitamura R, Iraha T, Nakasu A, Ishimine T, Yasutani T, Wake M, Tengan T. Endovascular Therapy for Distal Superior Mesenteric Artery Mycotic Aneurysms due to Infective Endocarditis. J Endovasc Ther 2019; 26:879-884. [DOI: 10.1177/1526602819865985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report 3 patients with infective endocarditis who underwent transcatheter arterial embolization for mycotic aneurysm of the distal superior mesenteric artery (SMA). Case Report: Three men (60, 64, and 65 years old) were diagnosed with infective endocarditis. Antibiotics were initiated immediately after admission and continued for several weeks to months. Distal SMA mycotic aneurysm was identified on computed tomography in the vicinity of the ileocolic artery at 33, 26, and 30 days after admission. In case 1, the ileal artery was occluded distal to the aneurysm, with collateral flow to the ileum. In case 2, the mycotic aneurysm was located below the ileocolic artery, which was stenosed distal to the lesion. In case 3, the aneurysm was located on a branch of the ileal artery. Transarterial embolization using microcoils was successfully performed in all patients. No complications associated with embolotherapy or relapse of infection were observed in these 3 patients at 60, 30, and 15 months, respectively. Conclusion: Transcatheter arterial embolization for distal SMA mycotic aneurysm could provide an alternative to open surgery. Anatomical assessment of collateral flow and preprocedure long-term antibiotic therapy could play important roles in preventing bowel ischemia and minimizing the risk of infection relapse.
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Affiliation(s)
- Wataru Higashiura
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Hiroaki Takara
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Ryoichi Kitamura
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Tomotaka Iraha
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Tohru Ishimine
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Tadashi Yasutani
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Minoru Wake
- Department of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Toshiho Tengan
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
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9
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Wang J, Cao D, Tong Q. Superior mesenteric artery branch pseudoaneurysm rupture mimicking acute pancreatitis in a patient with acute type B aortic dissection: A case report. Medicine (Baltimore) 2019; 98:e16442. [PMID: 31305471 PMCID: PMC6641738 DOI: 10.1097/md.0000000000016442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Visceral arterial pseudoaneurysms are rare but important vascular entities because of their inclination to cause life-threatening hemorrhage. They were commonly reported to be associated with trauma, infection, inflammatory disease, or occurred as postoperative complication. To date, there has been no published report of a superior mesenteric artery (SMA) branch pseudoaneurysm rupture mimicking acute pancreatitis in a patient with acute type B aortic dissection. PATIENT CONCERNS The patient's medical history, clinical information, imaging findings including follow-up computed tomography angiography (CTA), and treatment are reported. A 51-year-old male presenting with epigastric pain and fever was found to have an enlarged pancreatic head and obscure fatty space around it on abdominal nonenhanced CT. He has medical history of anaphylactoid purpura and uncontrolled hypertension. His serum lipase and amylase were both within normal limits. Thoracoabdominal CTA following a sudden blood pressure drop attributed to the accurate diagnosis. DIAGNOSES He was diagnosed with acute type B aortic dissection involving SMA and retroperitoneal hemorrhage secondary to SMA branch pseudoaneurysm rupture. INTERVENTIONS The patient was successfully treated by thoracic endovascular aortic repair without additional branch intervention. OUTCOMES Follow-up CTA at 3 months later demonstrated that the endoprothesis is well positioned with no endoleaks, and SMA branch pseudoaneurysm disappeared. LESSONS We report a rare and complicated case presenting with SMA branch pseudoaneurysm rupture and acute type B aortic dissection. CTA is vital in the diagnosis of such vessel pathology. We must inspect carefully to ensure that no small lesions are missed.
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Affiliation(s)
| | | | - Qian Tong
- Cardiovascular Center, The First Hospital of Jilin University, Chang Chun, Jilin Province, China
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10
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Nagamine H, Date Y, Takagi T, Kawase Y. Spontaneous complete resolution of mycotic superior mesenteric artery pseudoaneurysm. J Vasc Surg 2018; 68:1914-1915. [PMID: 30470372 DOI: 10.1016/j.jvs.2018.06.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Hiroshi Nagamine
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
| | - Yusuke Date
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Takeshi Takagi
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yushi Kawase
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
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11
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Blood Culture-Negative but Clinically Diagnosed Infective Endocarditis Complicated by Intracranial Mycotic Aneurysm, Brain Abscess, and Posterior Tibial Artery Pseudoaneurysm. Case Rep Neurol Med 2018; 2018:1236502. [PMID: 30533235 PMCID: PMC6250033 DOI: 10.1155/2018/1236502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022] Open
Abstract
Blood culture-negative endocarditis is often severe and difficult to diagnose. It is necessary to emphasize the importance for the early diagnosis and accurate treatment of blood culture-negative endocarditis. Here, we described the relevant clinical information of a blood culture-negative but clinically diagnosed infective endocarditis complicated by intracranial mycotic aneurysm, brain abscess, and posterior tibial artery pseudoaneurysm. This patient was a 65-year-old man with a 9-month history of intermittent fever and died in the end for the progressive neurological deterioration. Although the blood culture is negative, this patient was clinically diagnosed as infective endocarditis according to Duke criteria. This patient course was complicated not only by cerebral embolism, intracranial mycotic aneurysm, and brain abscess but also by posterior tibial artery aneurysm of the lower extremity. The clinical findings of this patient suggest that the confirmatory microbiology is essential for the treatment of blood culture-negative infective endocarditis. Clinicians should be aware of the detriment of blood culture-negative infective endocarditis for its multiple complications may occur in one patient. The delayed etiological diagnosis and insufficient treatment may aggregate the clinical outcome of blood culture-negative infective endocarditis.
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12
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Foppiano Palacios C, Riedel DJ. Breaking Away: Superior Mesenteric Artery Embolus. Am J Med 2018; 131:913-915. [PMID: 29649459 DOI: 10.1016/j.amjmed.2018.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Carlo Foppiano Palacios
- Departments of Internal Medicine and Pediatrics, University of Maryland Medical Center, Baltimore.
| | - David J Riedel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
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13
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Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. ACTA ACUST UNITED AC 2018; 51:e6864. [PMID: 29947649 PMCID: PMC6040868 DOI: 10.1590/1414-431x20186864] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022]
Abstract
The mortality of patients with mycotic aneurysms is high, especially in East Asia, and infection by Salmonella species is the most common. Our study aimed to improve prognosis of adult mycotic aneurysms with early diagnosis and accurate treatment. Four adult patients with mycotic aneurysm caused by Salmonella were included and analyzed by single-center retrospective analysis. Cases reported in the literature during the past 10 years were also summarized. The average age of the 4 male patients was 61.25 years, while that of the 53 cases reported in the literature was 65.13 years. Hypertension, diabetes, and atherosclerosis were common complications. Most patients presented fever and experienced pain at the corresponding position of the aneurysm. Laboratory examination found an increased number of white blood cells accompanied by an increase in inflammatory markers. Most aneurysms were found in the abdominal aorta, while the rupture of an aneurysm was the most common complication. The mortality rates were 21.43 and 7.14% after open surgery or endovascular aneurysm repair (EVAR) intervention, respectively. The recurrence rates of infection were 0 and 17.85% for both treatments, respectively. The mortality rate of mycotic aneurysm caused by Salmonella infection was high in middle-aged males with hypertension, diabetes, and atherosclerosis. The possibility of a Salmonella-infected aneurysm should be considered in these high-risk groups presenting chills, fever, chest, and back pain. Open surgery was superior to EVAR treatment in the clearance of infected foci and the reduction of postoperative recurrence. The recurrence of postoperative infection can be prevented by intravenous antibiotic therapy for 6 weeks post-surgery.
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Affiliation(s)
- Yiqun Guo
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yu Bai
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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14
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Guirgis M, Xu JH, Kaard A, Mwipatayi BP. Spontaneous Superior Mesenteric Artery Branch Pseudoaneurysm: A Rare Case Report. EJVES Short Rep 2017; 37:1-4. [PMID: 29234730 PMCID: PMC5651544 DOI: 10.1016/j.ejvssr.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 09/03/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023] Open
Abstract
Background Visceral arterial pseudoaneurysms (VAPAs) are rare vascular entities with serious consequences. Traditionally, they are associated with trauma, infection, and inflammatory disease, or they can arise as a post-operative complication. Report An 87 year old man presented with abdominal pain and was found to have a spontaneous VAPA on a computed tomography angiogram. Serial imaging 4 months previously had demonstrated no aneurysm. Between scans, warfarin was changed to apixaban for aortic valve replacement, but he had no other changes to any other medications. He required urgent endovascular coiling of the pseudoaneurysm, with satisfactory recovery and outcome. Discussion VAPAs are extremely rare, with splenic artery VAPAs the most commonly reported. Regardless, fewer than 250 cases of splenic artery pseudoaneurysm have been reported. Superior mesenteric artery (SMA) pseudoaneurysms are the rarest type of VAPAs. Early identification and urgent treatment are warranted because of the associated high mortality risk, with a 50% risk of rupture in any given VAPA. Treatment options range from open operation to endoscopic and endovascular procedures. Apixaban has been proposed to contribute to pseudoaneurysm formation by slow and continuous bleeding that results in the formation of the pseudoaneurysm. Conclusions Spontaneous VAPAs are extremely rare and this is the first time a VAPA has been associated with the novel oral anticoagulant "apixaban". Urgent management of any VAPAs is important because of the high risk of rupture and potential life threatening haemorrhage.
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Affiliation(s)
- Mina Guirgis
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Australia
| | - Jema Hua Xu
- Department of Vascular Surgery, Hollywood Private Hospital, Monash Ave, Nedlands, Perth, Australia
| | - Alar Kaard
- Department of Radiology, Hollywood Private Hospital, Monash Ave, Nedlands, Perth, Australia
| | - Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Wellington St, Perth, Australia.,School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, Perth, Australia
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15
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Dadon Z, Cohen A, Szterenlicht YM, Assous MV, Barzilay Y, Raveh-Brawer D, Yinnon AM, Munter G. Spondylodiskitis and endocarditis due to Streptococcus gordonii. Ann Clin Microbiol Antimicrob 2017; 16:68. [PMID: 28978355 PMCID: PMC5628438 DOI: 10.1186/s12941-017-0243-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Streptococcus gordonii is an infrequent cause of infective endocarditis (IE); associated spondylodiskitis has not yet been described in the literature. PURPOSE We describe 2 patients who presented with new-onset, severe back pain; blood cultures revealed S. gordonii bacteremia, which led to the diagnosis of spondylodiskitis and IE. We review our 2-decade experience with S. gordonii bacteremia to describe the clinical and epidemiological characteristics of these patients. RESULTS In our hospital over the last 20 years (1998-2017), a total of 15 patients with S. gordonii bacteremia were diagnosed, including 11 men and 4 women, and the mean age was 65 ± 22 (range 23-95). The most common diagnosis was IE (9 patients), spondylodiskitis (the presented 2 patients, who in addition were diagnosed with endocarditis), necrotizing fasciitis (1), sternitis (1), septic arthritis (1) and pneumonia (1). The 11 patients with IE were treated with penicillin ± gentamicin, or ceftriaxone for 6 weeks, 5 required valve surgery and 10/11 (91%) attained complete cure. The 2 patients with diskitis required 2-3 months of intravenous antibiotics to achieve complete cure. CONCLUSION Spondylodiskitis was the presenting symptom of 2/11 (18%) patients with S. gordonii endocarditis. Spondylodiskitis should probably be looked for in patients diagnosed with S. gordonii endocarditis and back pain as duration of antibiotic treatment to achieve complete cure may be considerably longer.
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Affiliation(s)
- Ziv Dadon
- Department of Internal Medicine A, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Assaf Cohen
- Department of Internal Medicine C, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yael M Szterenlicht
- Department of Internal Medicine C, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Marc V Assous
- Clinical Microbiology and Immunology Laboratory, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yair Barzilay
- Spine Unit of the Department of Orthopedics, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - David Raveh-Brawer
- Infectious Disease Unit, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Amos M Yinnon
- Division of Internal Medicine, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, P.O. Box 3235, 91031, Jerusalem, Israel.
| | - Gabriel Munter
- Department of Internal Medicine C, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
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16
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Plantar Purpura as the Initial Presentation of Viridians Streptococcal Shock Syndrome Secondary to Streptococcus gordonii Bacteremia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:9463895. [PMID: 27366188 PMCID: PMC4904574 DOI: 10.1155/2016/9463895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/01/2016] [Indexed: 12/03/2022]
Abstract
Viridians streptococcal shock syndrome is a subtype of toxic shock syndrome. Frequently, the diagnosis is missed initially because the clinical features are nonspecific. However, it is a rapidly progressive disease, manifested by hypotension, rash, palmar desquamation, and acute respiratory distress syndrome within a short period. The disease course is generally fulminant and rarely presents initially as a purpura over the plantar region. We present a case of a 54-year-old female hospital worker diagnosed with viridians streptococcal shock syndrome caused by Streptococcus gordonii. Despite aggressive antibiotic treatment, fluid hydration, and use of inotropes and extracorporeal membrane oxygenation, the patient succumbed to the disease. Early diagnosis of the potentially fatal disease followed by a prompt antibiotic regimen and appropriate use of steroids are cornerstones in the management of this disease to reduce the risk of high morbidity and mortality.
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