Aortic Aneurysm as a Cause of Hemoptyses

Abstract

Infected aortic aneurysms are a clinical condition associated with high morbidity and mortality. Hemoptysis has been reported following erosion of the aneurysm into the lung parenchyma. We present a 79-years-old woman, with history of a pseudoaneurysm of the descending aorta submitted to an endovascular correction with tubular stent in 2010. She arrived at the emergency department, in January/2016, referring asthenia and weight loss, with three months of evolution, associated with small volume hemoptysis, that had begun that day. The patient presented anemia and with hypoxemic respiratory failure. Angio-CT scan revealed hematoma of the aneurysmal sac, without indication for urgent intervention. She was admitted at an intermediate care unit. The patient kept small volume hemoptysis. A new thoracoabdominal angio-CT was performed compatible with infectious process/abscess of the periprosthetic aortic wall, associated with areas of parenchyma necrosis of the left lower pulmonary lobe, that may be the origin of hemoptysis. Empirical antibiotic therapy was instituted with pipracilina/tazobactam and linezolid. A methicillin resistant Staphylococcus aureus was identified in bronchial lavage, and piperacillin/tazobactam was suspended. After 6 weeks of antimicrobial therapy, she presented clinical improvement. This case demonstrates the complexity of managing a patient in which the infectious focus control is not possible, given the high surgical risk in a patient with multiple comorbidities. Doubts remain about the antibiotic therapy to be maintained and its duration.