Abstract
BackgroundInfective native aortic aneurysm (INAA) is a rare clinical diagnosis. The purpose of this study was to describe the CT findings of INAAs in detail.MethodsThis was a retrospective single-center study of INAA patients at a major referral hospital between 2005 and 2020. All images were reviewed according to a protocol consisting of aneurysm features, periaortic findings, and associated surrounding structures.ResultsOne hundred and fourteen patients (mean age, 66 years [standard deviation, 11 years]; 91 men) with 132 aneurysms were included. The most common locations were infrarenal (50.8%), aortoiliac (15.2%), and juxtarenal (12.9%). The mean transaxial diameter was 6.2 cm. Most INAAs were saccular (87.9%) and multilobulated (91.7%). Calcified aortic plaque was present in 93.2% and within the aneurysm in 51.5%. INAA instability was classified as contained rupture (27.3%), impending rupture (26.5%), and free rupture (3.8%). Rapid expansion was demonstrated in 13 of 14 (92.9%) aneurysms with sequential CT studies. Periaortic inflammation was demonstrated as periaortic enhancement (94.7%), fat stranding (93.9%), soft-tissue mass (92.4%), and lymphadenopathy (62.1%). Surrounding involvement included psoas muscle (17.8%), spondylitis (11.4%), and perinephric region (2.8%). Twelve patients demonstrated thoracic and abdominal INAA complications: fistulas to the esophagus (20%), bronchus (16%), bowel (1.9%), and inferior vena cava (IVC) (0.9%).ConclusionThe most common CT features of INAA were saccular aneurysm, multilobulation, and calcified plaques. The most frequent periaortic findings were enhancement, fat stranding, and soft-tissue mass. Surrounding involvement, including psoas muscle, IVC, gastrointestinal tract, and bronchi, was infrequent but may develop as critical INAA complications.
Highlights
Infective native aortic aneurysm (INAA), known as mycotic aortic aneurysm, is a challenging disease in respect of making the diagnosis [1, 2]
INAA may develop through various pathophysiological ways according to the amended Wilson’s classification [5, 6]: (1) due to septic emboli lodging in the aortic wall from infective endocarditis; (2) blood-borne bacteria inoculated in the aortic wall during bacteremia; (3) infection of a preexisting aneurysm due to blood-borne bacteria; and (4) aneurysms developing in patients with advanced human immunodeficiency virus infection
The European Society for Vascular Surgery 2019 guidelines [7] on abdominal aortic aneurysms recommend that the diagnostic workup of INAA should consist of a combination of: (1) clinical presentation; (2) laboratory results; and (3) computed tomography (CT) findings
Summary
Infective native aortic aneurysm (INAA), known as mycotic aortic aneurysm, is a challenging disease in respect of making the diagnosis [1, 2]. It is a rare entity found in only 0.6‒2.6% of all aortic aneurysms in western countries and up to 13% in Asia [3, 4]. The European Society for Vascular Surgery 2019 guidelines [7] on abdominal aortic aneurysms recommend that the diagnostic workup of INAA should consist of a combination of: (1) clinical presentation; (2) laboratory results; and (3) computed tomography (CT) findings. Infective native aortic aneurysm (INAA) is a rare clinical diagnosis. The purpose of this study was to describe the CT findings of INAAs in detail
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
