Mycotic Abdominal Aneurysm Research Articles

Abstract 10768: Double Whammy: An Unusual Case of Mycotic Abdominal Aortic Aneurysm in a Bacteremic Patient - Case Report

Introduction: Ruptured mycotic aortic aneurysm is a relatively rare, life-threatening disease, which is associated with remarkable mortality. In East Asia, mortality caused by this disease is high and it is commonly caused by Salmonella species. Majority of cases of mycotic aneurysms caused by Salmonella were in the abdominal aorta wherein most of them presented with chills and fever while some presented with diarrhea from 2 days to 1 month before the aneurysm was diagnosed. Patients who present with diarrhea and abdominal pain are likely to be missed. It is therefore important that mycotic abdominal aneurysm be recognized early, and prompt treatment be initiated. Case: A 78-year-old American male, Philippine immigrant with history of ischemic stroke and chronic smoking presented with diarrhea and severe abdominal pain. Complete blood count showed leukocytosis with neutrophilic predominance. A computed tomography scan of whole abdomen exhibited a fusiform aneurysm of the infrarenal abdominal aorta with large periaortic hematoma indicating prior rupture. Open abdominal aortic aneurysm repair was successfully done and intravenous Meropenem and Ciprofloxacin were given. Blood, urine, thrombus, and aortic plaque cultures were obtained and all revealed Salmonella specie with same antibiogram. Intravenous Meropenem and Ciprofloxacin was transitioned to intravenous Ceftriaxone and was continued for 6 weeks post-operatively. Conclusion: Mycotic abdominal aortic aneurysm can be diagnosed with the combination of clinical symptoms, laboratory, radiological findings, and intraoperative findings. However, vague and non-specific symptoms do not rule out the diagnosis. High index of suspicion and low threshold for CT imaging is necessary in any patient age >60 years who present with abdominal pain and with previous history of gastroenteritis. Prompt initiation of antibiotic therapy and surgical intervention are the treatment of choice.

Mycotic abdominal aneurysm secondary to salmonella infection

In the past 15 years, the diagnosis of mycotic abdominal aneurysm (MAA) has been based on various combination of the following 4 criteria; (1) clinical presentation (pain, fever, elderly patient with cardiovascular disease, and/or immunosuppressive state); (2) laboratory findings (raised inflammatory parameters and positive culture); (3) radiological findings on CT or MRI; (4) Intraoperative finings. The mortality of patients with mycotic abdominal aneurysm (MAA) is high and infection by Salmonella species is the most common.

S1410 Mycotic Abdominal Aneurysm Associated With Chronic Pancreatitis

INTRODUCTION: Vascular complications are a rare but serious manifestation of pancreatitis. The mechanism is thought to be due to inflammation and necrosis from local spread of proteolytic enzymes, compressive forces, or local infection. Splanchnic and gastroduodenal vessels are the most common given their proximity, but in rare cases, the aorta is affected. CASE DESCRIPTION/METHODS: A 53-year-old white male with long-standing chronic alcohol induced pancreatitis complicated by pancreatic ascites and pseudocysts presented with one day history of epigastric pain, nausea and emesis. Other history included gastroesophageal reflux, peptic ulcer disease complicated by a gastric bleed 4 months prior, and hypertension. He reported 37 pack years of tobacco use and marijuana use. He had a history of alcohol abuse but had been abstinent for the past 10 months. He denied intravenous drug use. His exam was notable for moderate distress due to pain, thin appearing (BMI 18), poor dentition, and epigastric tenderness to palpation without rebound or guarding. Labs were notable for a mild leukocytosis (WBC 16.7 g/L) and anemia (HGB 12.3 g/dL). His lipase was within normal limits (17 U/L). A CT scan revealed a bilobed aortic aneurysm (4.4 × 4.5 cm) with wall thickening and surrounding fluid and tissue suggestive of a mycotic aneurysm (Figures 1 and 2). Infectious workup including blood, fungal, and urine cultures, and bartonella and Q fever serologies was unrevealing. Comparison to a CT scan done 4 months prior showed periaortic inflammation and caliber of 2.4 cm (Figure 3). The patient was started on empiric antibiotics and surgery was consulted. Given the rapid expansion and complexity, he was deemed high-risk and completed outpatient antibiotics prior to surgery. He returned two months later for a planned open repair of the aneurysm with a rifampin-soaked graft. Intraoperative cultures and pathology were unrevealing for infections etiology. On outpatient follow up, his symptoms improved and had no signs of ongoing infection. He was placed on suppressive doxycycline and continues to do well 17 months later. DISCUSSION: Aortic pseudoaneurysms are a rare complication of pancreatitis with both infected and non-infected cases being reported in literature. Surgery is the definitive management, often done promptly upon diagnosis. Here we present a case of mycotic aortic aneurysm associated with chronic pancreatitis in which the surgical management was successfully postponed for infection control and stabilization of the patient.Figure 1.: CT angiography performed on admission showing bilobed aortic aneurysm above and below the renal arteries.Figure 2.: Abdominal CT on admission showing aortic aneurysm just superior to the renal arteries.Figure 3.: CT abdomen performed 4 months prior to admission aortic caliber just superior to the renal arteries.

Aortoenteric fistula after endovascular aortic repair of infected abdominal aortic aneurysm

Secondary aortoenteric fistula is a rare yet fatal condition that may occur as a complication after abdominal aortic aneurysm repair. Here, we report a case of a 66-year-old male with abdominal discomfort and intermittent fever at 5 years after endovascular aortic repair of an infected abdominal mycotic aneurysm. Surgical treatment with extra-anatomic bypass for lower body revascularization, followed by exploratory laparotomy with explantation of the infected graft and aortic tissue and repair of the duodenum were performed. The patient was rescued from the septic condition and discharged uneventfully 2 months postoperatively.

Huge Mycotic Abdominal Aneurysm with Nerve Irritation.

Huge Mycotic Abdominal Aneurysm with Nerve Irritation.

Ruptured Cryptogenic Mycotic Abdominal Aortic Aneurysm by Salmonella enteritidis

The aim of this study is to describe a case of ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis (SE) and present a comprehensive review of the literature. A 66-year-old man with a past medical history of coronary artery bypass graft (CABG) and polymylagia rheumatica (PMR) presented with a 2-day history of right-flank-to-groin pain and fever. He was found to have tenderness on the right of the umbilical region and laboratory data showed leukocytosis, raised C-reactive protein, and a significant drop in hemoglobin level as compared with his first visit 17 days earlier, with no hemodynamic instability. An immediate computed tomography angiogram (CTA) was performed, which showed a 4-cm, fusiform, ruptured infrarenal aortic aneurysm. Exploratory laparatomy was performed and the aorta was isolated and excised from the infrarenal level to the common iliac bificuration. A straight silver Dacron graft soaked in rifampicin was placed with an end-to-end anastomosis. The excised aorta and the lymph nodes were sent for histologic and microbiologic assessment. Blood culture and specimen microbiology grew Salmonella enteritidis (SE). The histology exhibited atherosclerosis at the rupture point with decreasing neutrophil deposition from the intima to the adventitia layer, respectively. Infrarenal abdominal mycotic aneurysm (MA) by SE was observed and showed vague, nonspecific signs and symptoms. We recommend a high index of suspicion and low threshold for use of CT imaging in any infected patient of age >60 years with fever and abdominal pain on a background of diabetes and connective tissue disease. A comprehensive review of the literature was performed due to a lack of consensus on the best surgical treatment and limited information on the path of SE-induced aortitis or MA from presentation to final outcome.

The Pieces of the Puzzle—Disseminated BCG Infection With Mycotic Abdominal Aneurysm Identified on a Blood Culture

Intravesicular bacillus Calmette-Guérin (BCG) instillation is a widely used immunotherapy for superficial bladder cancer. Although this treatment is generally well tolerated with primarily local adverse effects, systemic adverse effects, including fever, pneumonitis, and hepatitis, have been reported. A disseminated infection with the development of mycotic aneurysms is very rare and results in significant morbidity and mortality. We report an immunocompetent patient with disseminated BCG infection and mycotic aneurysms diagnosed based on imaging and a positive mycolytic blood culture and subsequently confirmed by histopathology. We review the literature of other cases of disseminated BCG infection with mycotic aneurysms and summarize the classic presentation, the treatment, and outcomes.

Mycotic Aneurysms in the Abdominal Aorta and Iliac Arteries: CT‐based Grading and Correlation with Surgical Outcomes

Computed tomography (CT) is the modality of choice in the diagnosis of mycotic aneurysms. The present study aimed to classify the CT findings of mycotic aneurysms, and to assess their predictive value based on the correlation of a CT-based grading system with prognostic factors and outcomes. Over the past 21 years, 40 consecutive patients underwent open surgery for mycotic aneurysms of the abdominal aorta and iliac arteries in our hospital. The CT appearances of mycotic aneurysms were categorized into four grades: grade 1, periarterial changes without destruction of the arterial wall; grade 2, presence of saccular outpouching; grade 3, extensive retroperitoneal infection; and grade 4, massive perianeurysmal hemorrhage. Clinical data were recorded for analysis. The surgical mortality and overall aneurysm-related mortality rates were 17.5 and 25%, respectively. The poor prognostic predictors were shock, rupture, and concomitant gastrointestinal procedures. The increasing proportions of shock and rupture status corresponded to mycotic aneurysms of higher grades in the CT-based grading. In addition, one patient in grades 1 and 2, versus five in grades 3 and 4 (P = 0.02), required concomitant gastrointestinal procedures. The CT-based grading exhibited a strong association with surgical mortality (Cramer's V coefficient = 0.65; P = 0.002) and a relatively strong association with overall aneurysm-related mortality (Cramer's V coefficient = 0.53; P = 0.01). For patients surgically treated for abdominal mycotic aneurysms, the CT-based grading is correlated with clinical severity, surgical complexity, and outcomes, and thus it may serve as a simple scale for risk classification.

Mycotic Abdominal Aneurysm Caused by Campylobacter Fetus: A Case Report for Surgical Management

We report a rare case of mycotic abdominal aortic aneurysm associated with Campylobacter fetus. A 72-year-old male admitted to the hospital because of pain in the right lower quadrant with pyrexia. The enhanced abdominal computed tomography (CT) examination showed abdominal aortic aneurysm (AAA) measuring 50 mm in maximum diameter and a high-density area of soft tissue density from the right lateral wall to the anterior wall of the aorta. However, since the patient showed no significant signs of defervescence after antibiotics administration, so we performed emergency surgery on the patient based on the diagnosis of impending rupture of mycotic AAA. The aneurysm was resected in situ reconstruction using a bifurcated albumin-coated knitted Dacron graft was performed. The cultures of blood and aneurysmal wall grew Campylobacter fetus, allowing early diagnosis and appropriate surgical management in this case, and the patient is making satisfactory progress. This is the fifth report of mycotic AAA characterizing culture positive for Campylobacter fetus in blood and tissue culture of the aortic aneurysm wall.

Community-acquired Methicillin-resistant Staphylococcus aureus Mycotic Aneurysm

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) continues to emerge as a cause of serious infections. We present the first case of abdominal mycotic aneurysm caused by Panton-Valentine leukocidin-positive CA-MRSA. This case adds another presentation to the clinical spectrum of CA-MRSA infections, and highlights the problem encountered in the choice of the therapy of serious community-acquired infections in an era of increasing CA-MRSA infections.

Saphenous Vein Spiral Graft: Successful Emergency Repair of a Mycotic Aneurysm with Aortoduodenal Fistula

Mycotic aneurysms leading to aortoduodenal fistula (ADF) are associated with high morbidity and mortality. We report a patient with a mycotic aneurysm and ADF who required emergency laparotomy. After excision of the aneurysm, vascular reconstruction was performed using an autologous graft. The left long saphenous vein was harvested and constructed into a spiral graft. The graft was inserted using a standard inlay technique. After 12 months the patient is in good health. No inflammation or dilation of the saphenous vein spiral graft has been noted. We suggest that in the emergency treatment of mycotic abdominal aneurysm, aortic reconstruction with saphenous vein spiral graft is a valuable option.

Mycotic abdominal aneurysm: report of a case with emphasis on the presence of gas echoes

Mycotic abdominal aneurysm is a relatively rare disease and its sonographic (US) findings have rarely been reported. We present a case of mycotic aneurysm of the common iliac artery in which the initial US showed a slightly wall-thickened abdominal aorta with gas echoes in the wall, a second US 6 days later showed a rapid increase in aortic size, and an emergent surgical intervention showed a mycotic aneurysm. This interesting observation suggested that the presence of gas echoes is a useful US finding indicating the beginning of a mycotic aneurysm and, when encountering this US finding, that emergent treatment should be considered to prevent delay in patient management.

Abdominal mycotic aneurysm due to Streptococcus zooepidemicus

Streptococcus zooepidembs is a common animal pathogen. It infects domestic and laboratory animals and has been found to cause respiratory infections in horses and, infrequently, mastitis in cows. Clinical infections in humans are uncommon and are usually associated with ingestion of unpasteurized milk or contact with horses (1). In this article we present a fatal case of abdominal mycotic aneurysm in a 71-yrold hotel owner who regularly consumed raw cow’s milk. On November 11.1994, a 71-yr-old man was admitted to the emergency de: part the C-reactive protein had declined during hospitalization horn 30.5 to 19.5. During this period he remained afebrile with single spikes up to 38.3”C. At discharge, the patient appeared to be seriously ill.

Detection of an Abdominal Mycotic Aneurysm on Three-Phase Bone Scan A Case Report

A 46-year-old male had low back pain, radiating into the legs, of 4 weeks duration. The patient described a single episode of bloody diarrhea 3 weeks previously, and for the past 3 days had complained of a low grade fever. Abdominal ultrasound and colonoscopy results were negative. Vertebral osteomyelitis was suspected and the patient was referred for a bone scan. The dynamic flow study demonstrated a focal area of increased activity on the anterior view just above the aortic bifurcation extending to the left. This activity was less intense on the blood pool images, while delayed images were normal. The scintigraphic findings were consistent with an abdominal aneurysm. Because an infectious process was suspected on the basis of the history, the possibility of a mycotic aneurysm was questioned. A repeat ultrasound, as well as a CT scan were performed. This confirmed the presence of a 4 cm saccular aneurysm arising from the anterior wall of the aorta just above the bifurcation. Salmonella enterititis was cultured from the resected specimen

A mycotic aneurysm of the abdominal aorta in a child

A 6-year-old boy with a previous history of intracardiac correction of a partial atrioventricular canal defect presented with infective endocarditis. Despite antibiotic therapy and reoperation, he developed a mycotic abdominal aneurysm. In situ aortoiliac reconstruction with a prosthesis and an omental flap was performed. At follow-up after 2 $${\raise0.5ex\hbox{$\scriptstyle 1$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 2$}}$$ years there were no signs of prosthetic infection or problems with the anastomoses.

Primary Mycotic Abdominal Aortic Aneurysm Due to Candida—A Case Report

A sixty-eight-year-old man with a huge abdominal aortic aneurysm devel oped disseminated candidiasis immediately after surgery. Candida organisms were present in the aneurysm content in the blood and, later, in the brush speci mens of the lungs. The authors believe that this is the first reported abdominal mycotic aneurysm due to Candida.