Search

Sepsis from an infected cardiac valve can lead to bacterial seeding and destruction of the arterial wall with formation of a mycotic aneurysm. The natural history of these lesions is the rupture. We report the case of a 20 year old female who was admitted to our institution with massive mitral regurgitation and emboli of the central nervous system and both lower extremities. She underwent emergency valve replacement and then, staged treatment of her ischemic legs and multiple asymptomatic mycotic aneurysms: Superior mesenteric, right common iliac and left superficial femoral arteries. A splenectomy was required to treat a splenic abscess. An aneurysm of a peripheral branch of the middle cerebral artery was medically treated, demonstrating reduction in size on subsequent angiogram. She recovered uneventfully and remains asymptomatic after 20 months of follow up. The development of new diagnostic and therapeutic tools has led to a decrease of these complications during infectious endocarditis. However, in the patient with late diagnosis and symptoms in different territories, the mycotic aneurysm must be kept in mind to provide the patient with appropriate treatment.

53 year old men suffered from abdominal pain, vomiting, lack of appetite, loss of weight, with ESR > 100 mm Hg and moderate anaemia was presented. Many diagnostic procedures were without results and finally laparotomy was taken. The microscopic examination of specimen of periaortic tissue revealed retroperitoneal fibrosis accompanying atherosclerotic aortae. Corticotherapy and antilipemic drugs were given. After 3 years a complete remission of periaortic pathologic mass was observed. This case could prove the autoimmunological hypothesis of retroperitoneal fibrosis.

We describe a 27y old female systemic lupus erythematosus (SLE) patient with salmonella bacteraemia who presented with fever, back pain and an enlarging heart size. A two dimensional echocardiogram (2D Echo) showed a mass in the right atrium. Subsequent computer tomographic (CT) and magnetic resonance imaging (MRI) studies showed that this had become a ring shaped lesion at the posterior end of the interventricular septum with an area communicating with the right atrial cavity. At operation a ruptured mycotic aneurysm of the right coronary artery was found. This is the first report of an SLE patient with a coronary artery mycotic aneurysm due to salmonella and the first reported case of survival following rupture of such aneurysm.

A case of atherosclerotic abdominal aortic aneurysm, complicated by aortoenteric fistulizations and infected by Escherichia coli, is presented. Chronic contained rupture resulted in the formation of a huge left psoas abscess which was responsible for the symptoms. No similar case has been reported in the literature. Resection and extra-anatomic vascular reconstruction were curative.

A patient with subacute bacterial endocarditis and a peripheral mycotic aneurysm is presented. We used a combined multi-slice surface anatomy scanning (SAS) and contrast-enhanced MR angiography image to determine the exact location of the small lesion by applying a skin marker on the scalp and visualizing the relationship of the marker to the brain surface structures and to the lesion. This technique was useful for the removal of a small peripheral aneurysm using only a limited craniotomy.

Infected aortic aneurysms remain a difficult surgical problem associated with high morbidity and mortality. We report three cases of mycotic thoracoabdominal aneurysms treated by debridement of infected aortic tissue, in situ prosthetic graft replacement, and intensive antibiotic therapy. One early death occurred in a patient with systemic sepsis related to Salmonella enteritidis infection of the thoracic aorta secondary to a colovesical fistula. The two other patients remain alive at 2 years without further complications of the surgery. Bacteriology is as follows: Staphylococcus aureus, Streptococcus pneumoniae, and Salmonella enteritidis. In all patients the operation was performed immediately after the diagnosis was confirmed. Antibiotic therapy was begun intraoperatively and was continued for at least 6 months. Two patients were followed regularly, and there have been no septic recurrences in our 2-year follow-up period. In situ prosthetic graft replacement in conjunction with intensive antibiotic therapy is a viable option in the treatment of mycotic thoracoabdominal aortic aneurysms.

Spontaneous rupture of an aortic aneurysm into the pulmonary artery is unusual and is rarely reported in the literature. The case of a patient with a syphilitic aneurysm of the ascending aorta perforated into the pulmonary artery is presented. In an attempt to define the best surgical treatment for this complication the literature has been comprehensively reviewed.

53-year-old male was introduced our hospital for treatment of his infective endocarditis and congestive heart failure. Further evaluation revealed massive destruction of the mitral valve and aneurysm of the right coronary artery. We carried out an operation of aneurysmectomy and CABG with RGEA for coronary artery, and MVR using 29 mm SJM valve. Postoperative course was excellent. Graftgram showed good patency and perfusion of RGEA. Pathological findings were 1) macrophage infiltration into thrombi, 2) disappearance of elastic fibers of the media. 3) least atherosclerosis of the intima. We concluded that it was a mycotic coronary artery aneurysm. There have been no report of surgical treatment of such a mycotic coronary artery aneurysm upon our investigation.

Two cases of infected atherosclerotic aneurysms thought to have arisen following haematogenous seeding of atheromatous lesions are described. Although infective endocarditis also arises by the haematogenous route, there are striking contrasts in both the range and therefore likely source of organisms, together with a perceived difference in the rate of blood-culture positivity. This case report provides a focus for discussion of these observations.

Extracranial mycotic aneurysms of the carotid are unusual. We present such an aneurysm of the right primary carotid caused by enteritis due to Salmonella in a 75-year-old patient at high risk for surgery (myocardial ischemia evolving over 3 months) and with coexisting stenosis of 75% of the left internal carotid. Endarterectomy of the left internal carotid, with shunting, was performed, after which the right primary carotid was tied during the same operation. Epidural anesthesia to C6-C7 was provided through a catheter supplemented with an intravenous propofol infusion. Neurological and hemodynamic variables monitored during surgery were stable. No neurological deficits or myocardial ischemic changes were recorded. Three months after discharge the patient was asymptomatic.

A 55-year-old man was admitted with complaints of headache, diplopia, fever and swelling of the right eyelid. Physical examination revealed low grade fever of 37.6 degrees C, but no evidence of infectious focus was detected. The neurological examination disclosed right abducens nerve palsy. An initial routine blood count showed an increased white blood cell count of 11,800/microliters. The erythrocyte sedimentation rate was 93mm and the C-reactive protein level was 3.6mg/dl. Massive epistaxis and hypovolemic shock developed on the 14th day while the patient was receiving antibiotics (CEZ, CMZ) for a possible intracranial infection. The magnetic resonance angiography of the brain and the cerebral angiography demonstrated an aneurysm within the cavernous sinus, which had not been present on the admission. Since epistaxis was caused by a rupture of the aneurysm, internal carotid artery ligation was done. The signs of inflammation improved as well as patients' symptoms. The improvement while using antibiotics strongly implies that the aneurysm was a result of bacterial infection of the cavernous sinus. There have been no reports of ruptured bacterial intracavernous aneurysms presented with massive epistaxis as this case.

We report the case of a 32-year-old man with a mycotic aneurysm of the left subclavian artery. This patient had immunosuppression caused by chemotherapy administered for treatment of leukemia. This aneurysm was revealed by two episodes of hemoptysis caused by a lung parenchyma fistulization. The patient was treated successfully by simple ligation and exclusion via a thoracotomy with partial lung resection. Histologic examination confirmed the presence of aspergilloma filaments in the false aneurysm. We suspect that aspergilloma could have been the cause of the mycotic aneurysm in this particular case. The literature on subclavian artery mycotic aneurysms is reviewed.

We report a case of an aortoesophageal fistula secondary to a mycotic aneurysm of the descending thoracic aorta in which the actively bleeding fistulous tract was demonstrated on contrast-enhanced CT, allowing definitive diagnosis.

The treatment of choice for the septic aortic prosthesis remains graft excision and extra-anatomic revascularization usually with axillofemoral bypass. Several recent retrospective series report secondary graft infection rates in these remedial procedures that range from 5-10%. In this setting, proximal axillary artery anastomotic disruption with pseudoaneurysm formation poses an especially vexing problem for the surgeon. We report a case of secondary graft infection presenting as unusually large, perianastomotic pseudoaneurysm formation. Our desire to avoid thoracotomy and the potential intrathoracic spread of infection prompted us to achieve proximal control by endovascular means. Balloon occlusion of the axillary artery proximal and distal to the graft anastomosis was achieved angiographically by percutaneous puncture of the ipsilateral brachial artery at two separate sites. This facilitated prompt removal of the infected graft with minimal intraoperative blood loss. Our favorable experience with this approach suggests a role for its more general application in the management of infected perianastomotic pseudoaneurysm.

Septicaemia and mycotic aneurysm may occur in a patient who is an enteric-carrier of Salmonella typhimurium. We report such a case of an elderly man who presented with chest pain and fatal massive haemoptysis from a likely mycotic thoracic aneurysm. This report underscores the importance of increased awareness of the disease which may allow more frequent and earlier diagnosis.

One year ago, a 48-year-old man complained of dyspnea, and was diagnosed as mitral valve regurgitation and aortic dissection. He underwent mitral valve replacement and aortic arch grafting. He was also pointed out to have an inflammatory aortic aneurysm (IAAA) in the infrarenal abdominal aorta, but did not undergo surgery. At this admission, he had lumbago and low grade fever probably due to deterioration of the IAAA. On the preoperative radionuclide studies, inferior vena caval obstruction and bilateral ureteral obstruction or severe stenosis were demonstrated by 99mTc-MAA venography and 123I-OIH renogram, respectively. 67Ga scan showed faint abnormal accumulation at the IAAA. He underwent surgery. IAAA had a thick wall in white and hard fibrotic tissue adhered closely to duodenum, jejunum, inferior vena cava and bilateral ureters. After surgery, his renal function was improved. In this case, radionuclide studies were useful for detecting the inferior vena caval obstruction, assessing renal function and inflammatory activity.

While rare, mycotic aneurysms of the aorta have a high mortality rate from immediate rupture and late complications. The case of a patient with a ruptured mycotic aneurysm is presented, and the important role of scintigraphic studies in the early detection of complicating extensive soft-tissue infection and osteomyelitis is demonstrated.

Since 1976, 37 patients have undergone valve replacement for infective endocarditis at our institute. Twenty patients required surgery during the active stage and 17 in the inactive stage. The former group consisted of 17 native and three prosthetic valve endocarditis, and all patients in the latter group had native valve endocarditis. Eighteen patients had AVRs, 15 had MVRs and four had DVRs. Congestive heart failure was the indication for surgery in 80% of the active and 100% of the inactive group. There were nine early deaths (45%) and one late death in the active group, and one early (6%) and one late death in the inactive group. Operative mortality in the active group, however, has recently been reduced to 30% for the 10 patients operated upon in the past two years. Two patients with active endocarditis were complicated by rupture of cerebral mycotic aneurysms postoperatively and resulted in one early and one late death, respectively. It is suggested that timely surgical intervention according to the hemodynamic state of the patients is essential in reducing early mortality in infective endocarditis. Attention should be paid to cerebral mycotic aneurysm as one of the problems affecting on postoperative mortality and morbidity.

We report a case of rupture of an acquired sinus of Valsalva aneurysm secondary to Aspergillus endocarditis in a patient with chronic lymphocytic leukaemia and idiopathic thrombocytopaenia purpura. Despite adequate repair and haemodynamic correction, with an apparent excellent initial result, the patient died of overwhelming sepsis at twelve days postoperatively. This case demonstrates an unusual cause of rupture of a sinus of Valsalva aneurysm and the morbidity associated with immunological dysfunction in the post-operative period.

A 67-year-old man was admitted to hospital because of fever, productive cough and a concomitant hoarseness. A para-aortic lesion was found on chest X-ray, and bronchoscopy revealed a left vocal cord palsy. Due to rapid enlargement of the lesion, angiography was performed, which revealed a pseudoaneurysm at the descending aorta. Operation disclosed an infected aneurysm with rupture, and tissue culture yielded Salmonella cholerasuis. The findings of a mycotic aneurysm and hoarseness due to compression of the left recurrent laryngeal nerve is a rare and serious combination caused by salmonella, previously unreported in the medical literature.

Two years after a Staphylococcus aureus septicaemia, in a patient with dermatopolymyositis occurred an infectious aneurysm of abdominal aorta with contiguous pyogenic spondylodiscitis. Coexistence of both pathologies is rare and physiopathological mechanisms still remain uncertain. However, many arguments in the present case report are in favour of the initial responsibility of an infectious aneurysm. Main interest in early diagnosing infectious aneurysm, allowed by new investigations such as magnetic resonance imaging and marked leukocyte bone scanning, is the prevention of major complications. Antibiotherapy and surgical removal of infectious aneurysm must be quickly achieved in every case.

Infective pseudoaneurysm of External iliac artery, a new complication of appendicular abscess is described. It's etiopathogenesis, clinical presentation and management are briefly reviewed.

Background: In 15% to 20% of patients with a spontaneous subarachnoid hemorrhage, no aneurysm is found on the first angiogram. This review emphasizes that this group of patients is in fact heterogeneous and describes the clinical features, pattern of hemorrhage on early computed tomographic (CT) scan, prognosis, and proposed management in the several and distinct subsets of these patients., Summary of Review: Patients in whom no aneurysm is revealed on the initial angiogram can be subdivided mainly according to the pattern of hemorrhage on an early CT scan. In two thirds of these patients the CT scan shows a perimesencephalic pattern of hemorrhage (ie, blood confined to the cisterns around the midbrain); these patients invariably have a good prognosis, which obviates the need for a second angiogram. Patients with diffuse or anteriorly located blood on CT scan are at risk of rebleeding. In most of these patients the source of hemorrhage is an occult aneurysm, but intracranial artery dissections, dural arteriovenous malformations, mycotic aneurysms, trauma, bleeding disorders, substance abuse, or a cervical origin of the hemorrhage should also be considered. Patients with no blood revealed on an early CT scan but with xanthochromic cerebrospinal fluid are extremely rare. These patients deserve a second reading of the scan for blood in the prepontine cistern, which can be the only site of hemorrhage in perimesencephalic hemorrhage., Conclusions: The prognosis and management of patients in whom no aneurysm is found on the initial angiogram depends on the pattern of hemorrhage on the initial CT scan. Patients should no longer be designated with the umbrella term "angiogram-negative subarachnoid hemorrhage."

Direct graft replacement with local debridement and prolonged administration of antibiotics was used in the treatment of six patients with mycotic thoracoabdominal aneurysms. The only early death occurred in a patient with systemic sepsis related to Staphylococcus aureus mycotic suprarenal aneurysm. Long-term survival of the remaining patients has been excellent: two patients died of unrelated causes at 5 and 6 years, respectively; one patient remains alive with known persistent infection at 5 years; and the remaining patients are alive with no evidence of infection at 1 1/2 and 10 years, respectively. Percutaneous aspiration of infected perigraft fluid with local instillation of antibiotics along with administration of intravenous antibiotics may provide palliation in selected patients with recurrent infections. In view of the magnitude of the problems associated with recurrent infection, life-time administration of antibiotics is recommended after in situ graft replacement of mycotic thoracoabdominal aneurysms.

Background: Mycotic aneurysms are classic complications of infective endocarditis. Their diagnosis can be difficult when they are located in deep vessels., Case Report: A 8 year-old boy was admitted for psoitis, tenderness of the left iliac fossa and a palpable mass. He was treated with antibiotics for 2 months for infective endocarditis, but vomiting and fever began after 3 weeks of therapy. Blood cultures showed Staphylococcus epidermidis. Ultrasonography of the mass showed findings compatible with an abscess but sampling of its contents showed blood. Immediate Doppler echography showed that the mass was an aneurysm of the left iliac artery. This diagnosis was confirmed by CT scan and aortography. The aneurysm was excised and a satisfactory repair was made using a Gore-tex graft., Conclusion: Although this mass had no clinical vascular characteristics, its origin should have been recognized because of the history of infective endocarditis and a better analysis of the ultrasonographic findings.

Background: Serious complications, such as emboli and mycotic aneurysms, are still frequent in documented cases of infective endocarditis. Infecting organisms other than Streptococcus viridans and Staphylococcus are becoming more common., Case Report: A 8 year-old girl was admitted because of a sudden pain in the right calf followed by complete disability. She had low-grade fever and presented with a moderate heart murmur with no sign of congestive heart failure, a severe pain at palpation of her calf with no Homans sign; she had many dental caries. Laboratory data indicated leukocytosis with increased percentage of polymorphonuclear cells and increased sedimentation rate. Ultrasonography of the calf showed laceration of the muscle with blood suffusion. Echocardiography showed vegetations involving the mitral valve. Intravenous antibiotic therapy with penicillin G and netilmicin was instituted, but mitral insufficiency appeared 7 days later while the fever persisted. At that time, the brain CT scan showed ischemic lesions, while angiography showed several mycotic aneurysms. Neisseria mucosa was recovered from the 5 initial blood cultures 16 days after the onset, and penicillin G was replaced by ampicillin. A second vegetation involving the aortic valve was seen a few days later, and a recent arterial embolism to the right leg was suspected because fever and pain reappeared. The brain ischemic lesions gradually disappeared and a second angiography performed 3 months after the first showed that all but one large mycotic aneurysm had disappeared; this last aneurysm was excised. Four years later, the child is in good health without any neurological sequelae but having mitral insufficiency., Conclusion: This girl presented with classical complication of infective endocarditis due to Neisseria mucosa, a saprophytic organism of the oral cavity. This is the second report of such an infection in children.

We report the case of a 37-year-old woman who presented to the emergency department with the initial complaint of complete blindness. The patient was found to have bilateral ruptured occipital mycotic aneurysms as a sequela of bacterial endocarditis. This case is unique in several aspects. Although blindness may be a presenting neurologic symptom, it is exceedingly rare. To our knowledge, bilateral cortical blindness secondary to mycotic aneurysm rupture has not been reported previously.

Infected aneurysms of the popliteal artery are rare and Salmonella enteritidis infection in this site has not been previously reported. In the case reported herein, septic thrombophlebitis was found to be in contact with the aneurysm. Preoperative diagnosis was made through arteriography, computed tomographic (CT) scan, and positive blood cultures. The infected aneurysm was treated by resection without any reconstruction while phlebitis was treated by thrombectomy. Appropriate antibiotic therapy was administered. The patient made an uneventful recovery.

We present two cases of ruptured mycotic aneurysms infected with Staphylococcus aureus. Each patient had hemoptysis and in each case there was hemothorax caused by a ruptured mycotic aneurysm of the celiac artery. In case 1, the pathogenesis was transient Staphylococcus aureus septicemia infecting an atherosclerotic plaque with subsequent aneurysm formation and rupture. In case 2, the septicemia arose from an infected knee. The presentation of a celiac artery aneurysm as hemoptysis and as the cause of hemothorax is rare.

A 65-year-old man had a 3-day history of sore throat, fever, rigors, back pain, abdominal discomfort, nausea, vomiting, and diarrhea. The patient's daughter had group A streptococcus pharyngitis. The patient was found to have a ruptured abdominal aortic aneurysm. He underwent resection of the aneurysm and right axillary femoro-femoral bypass graft. The patient died 40 hours after admission. Gram stain of the aneurysm showed numerous gram-positive cocci. Group A streptococcus grew from cultures of blood, throat, and aneurysm. The group A streptococcus was M type 3, T type 3 and produced streptococcal pyrogenic exotoxin A. This case is a very rare fatal complication of group A streptococcus pharyngitis.