Air in the aortic wall: A rare case of Clostridium septicum aortitis

Abstract

An 81-year-old male presented to the emergency department with a 48-h history of central chest pain radiating to the back. Observations revealed hypoxia, tachycardia, and hypotension. Biochemistry revealed raised inflammatory markers (white cell count: 18.5 × 109/L and C-reactive protein: 62.5 mg/L) and reduced renal function (creatinine: 157 μmol/L and urea 10.2 mmol/L). Computed tomographic (CT) scan (CT aortogram) revealed the presence of air in a diseased thoracic and abdominal aorta wall with no evidence of aneurysm (A, B, and C). Wall thickening at the cecal pole was noted as well (D). A diagnosis of acute aortitis was made, and the patient was started on intravenous antibiotics. Blood cultures isolated Clostridium septicum. Follow-up CT aortogram performed at 2 weeks revealed a resolution of the pockets of air. Colonoscopy revealed the presence of a fungating cecal mass (adenocarcinoma) as a source of bacteremia leading to aortitis; further, staging identified the disease as nonresectable.