Abdominal septic aortic pseudoaneurysm caused by <Emphasis Type="Italic">Campylobacter jejuni</Emphasis> infection: Report of a case

Campylobacter jejuni infection is one of the most common bacterial causes of acute gastroenteritis worldwide. An extraintestinal manifestation is rare and, to our knowledge, an aortic aneurysm has until now never been documented. We report a case of a 72-year-old patient with a septic aortic pseudoaneurysm caused by C. jejuni infection. Computed tomography and magnetic resonance imaging showed a pseudoaneurysm in the abdominal aorta. The preoperative blood culture indicated a Gram-negative bacillus, which was identified 7 days later as C. jejuni. An aneurysmectomy, extensive debridement, and an in situ graft wrapped with the omentum were done, and the patient was given a 6-week course of antibiotics. Despite readmissions for abdominal infection and Salmonella bacteremia, a graft infection did not develop. In the 3 years since the procedure the patient has shown no signs of a relapse.     

Management of Mycotic Aneurysm Following Repair of Corrected Transposition

Omental flaps have been used for the treatment of infected aortic prosthetic grafts in adults. We report the case of a 26-month-old male who developed a mycotic aneurysm 9 months following insertion of a ventricle to pulmonary artery conduit. The aneurysm was excised and the reconstructed outflow tract wrapped with omentum. The patient has not had recurrence of his aneurysm following this course of management. (J Card Surg 1994;9:55–60)     

Postoperative pseudoaneurysm of the superficial temporal artery (S.T.A.) treated with <Emphasis Type="Italic">Thrombostat</Emphasis>® (thrombin glue) injection

Summary Background. Pseudo-aneurysm is a rare complication of craniotomy. Blunt injury to the temporal artery region is the usual cause, but still a rare complication.Clinical presentation. A patient with subarachnoid hemorrhage was successfully treated by aneurysm clipping. The patient developed hydrocephalus, and was admitted for a shunt operation seventeen days later. The craniotomy had healed normally, but a palpable temporal lump was present in the skin incision.Intervention. The pulsating mass proved to be a postoperative aneurysm of the superficial temporal artery (S.T.A.) and was successfully occluded with 500 units Thrombostat® (thrombin glue) which was injected into the aneurysm sac using a 22-gauge needle guided by ultrasound.The permanency of the obliteration was verified by ultrasound examination.     

Infected aortic aneurysm,purulent pericarditis,and pulmonary trunk rupture caused by methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis>

A 66-year-old woman presented with cardiac tamponade. Pericardiocentesis revealed purulent pericarditis. Enhanced computed tomography showed a saccular aneurysm of the aortic arch. An irregularly shaped and partially enhanced mass was seen adjacent to the aneurysm, which suggested development of a mycotic pseudoaneurysm. Surgical drainage was performed through a subxiphoid incision, and continuous irrigation was commenced. On the following day, however, massive bleeding was recognized through the drains. The patient was immediately transferred to the operating theater, and extracorporeal circulation was established. A perforation 1 cm in diameter was found on the anterior surface of the pulmonary trunk, and a large amount of pus came out from the tear. The ascending aorta and the arch were found to be infected. Surgical repair was impossible due to extensive infection, and the patient died. Methicillin-resistant Staphylococcus aureus was isolated from the pericardial effusion, blood, and intraluminal thrombus of the aortic aneurysm.     

Ruptured inflammatory aortic aneurysm with aortoenteric fistula and infected with <Emphasis Type="Italic">Streptococcus pneumoniae</Emphasis>: a review of the literature

We present a case report of a 65-year-old gentleman who presented with an aortoenteric fistula along with a review of the literature. He was found, in addition, to have an inflammatory infrarenal aortic aneurysm with a posterior rupture. Cultures of the aneurysm sac confirmed a Streptococcus pneumoniae infection. The patient had previously presented with pneumonia. Antibody testing revealed an isolated pneumococcal IgG deficiency. The case demonstrates the diverse pathologies associated with aortic aneurysms and a need to be vigilant and occasionally expect the unusual.     

Dissecting aneurysm of the thoracic aorta in a patient with nephrotic syndrome and brucellosis

We report the case of a 61-year-old man with nephrotic syndrome due to glomerulonephritis and chronic brucellosis complicated by dissecting aortic aneurysm. The patient worked as a veterinarian and was diagnosed for chronic but non-active brucellosis with positive serum test for Brucella melitensis in the past. Administration of cyclosporine in combination with low dose prednisone resulted at least in proteinuria reduction and partial remission for 3 years. Dissecting aortic aneurysm was treated by insertion of a stent-graft, that resulted in canalization of blood flow and retraction of aneurysm wall later in the course in our patient.     

Development and rupture of a <Emphasis Type="Italic">de novo</Emphasis> basilar artery aneurysm after surgical removal of a cerebellar arteriovenous malformation

Summary ¶Background. The de novo development of an aneurysm in an previously normal artery is an uncommom event. We describe a patient who developed a de novo bleeding aneurysm of the basilar artery in the three weeks following the surgical removal of a large cerebellar AVM. Method-findings. A 48-year-old man suddenly developed transient headache, vertigo and disturbance of balance. Neuroradiological examinations showed the presence of a large AVM of the right cerebellar hemisphere. The AVM was removed successfully; following the operation there were repeated bleeding episodes at the operating site, requiring surgical evacuation. Three weeks after the AVM removal he suffered from a massive subarachnoid haemorrhage due to the rupture of an aneurysm developed de novo in the basilar artery. Interpretation. This is the first reported case, to our knowledge, of a de novo aneurysm developed in an artery hemodynamically related to a surgically removed AVM. This complication was probably due to the postoperative hemodynamic changes in the vessels afferent to the AVM, associated with arterial wall dysplasia.     

Infective aneurysm of the popliteal artery due toSalmonella Enteritidis

Infected aneurysms of the popliteal artery are rare andSalmonella 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.     

<Emphasis Type="Italic">Candida albicans</Emphasis>-Infected Pancreatic Pseudocyst: Report of a Case

We report the case of a 48-year-old man with a pseudocyst infected by Candida albicans, and review the relevant literature. The patient was successfully treated by a Roux-en-Y cystojejunostomy of the pseudocyst and adjunctive therapy with amphotericin B. Candida species isolated from a pancreatic pseudocyst or abscess should be considered pathogenic, and treated aggressively.     

Mycotic Aneurysm of the Brachial Artery Secondary to Hospital-Acquired Methicillin-Resistant Staphylococcus epidermidis in a Complicated Case of Infective Endocarditis

We present a case of brachial artery mycotic aneurysm caused by methicillin-resistant Staphylococcus epidermidis in a patient with infective endocarditis. A 66-year-old woman suffered two transient ischemic attacks over an 8-week period secondary to septic emboli from mitral valve endocarditis. Following valve replacement surgery, the patient was troubled by persisting paresthesia in the right hand. A mycotic aneurysm of the brachial artery was diagnosed, and surgical repair was successfully undertaken. The purpose of this case report is to highlight an unusual causative organism for mycotic aneurysm and to underline the increasing threat of multi-drug-resistant bacteria as a cause of vascular disease.     

Mycotic aneurysm of the aortic arch due to Salmonella

We report the successful treatment of a 79-year-old man with an extremely rare mycotic aneurysm of the aortic arch due to Salmonella. The patient presented with persistent fever, hoarseness, and hemosputum. Computed tomography showed a large saccular aneurysm with a hazy aortic wall in the aortic arch. We conducted emergency total arch replacement, debriding surrounding infectious tissue. Cultures from the aneurysm grew Salmonella enteritidis. Infection recurred 1 week postoperatively, requiring open irrigation and omentum transposition. These surgical procedures, along with appropriate antibiotics, brought infection under control.     

Bacteroides <Emphasis Type="Italic">fragilis</Emphasis> aortic arch pseudoaneurysm: case report with review

We present a case of 58-year-old woman with underlying diabetes mellitus, hepatitis C virus-related liver cirrhosis, and total hysterectomy for uterine myoma 11 moths ago, who was diagnosed ruptured aortic arch mycotic pseudoaneurysm after a certain period of survey for her unknown fever cause. After emergent surgery with prosthetic graft interposition, all her blood cultures and tissue cultures revealed pathogen with Bacteroides fragilis. Although mycotic aneurysms have been well described in literatures, an aneurysm infected solely with Bacteroides fragilis is unusual, with only eight similar cases in the literature. Here we reported the only female case with her specific clinical and management course and summarized all reported cases of mycotic aneurysm caused by Bacteroides fragilis to clarify their conditions and treatments, alert the difficulty in diagnosis, and importance of highly suspicious.     

Type B aortic dissection associated with <Emphasis Type="Italic">Salmonella</Emphasis> infection

A 59-year-old man with a long history of hypertension and diabetes was admitted to our hospital with acute type B aortic dissection 14 days after the sudden onset of back pain. The dissecting descending thoracic aorta was enlarged to 5.2 cm in diameter, and laboratory tests showed an elevated white blood cell count (15 530/mm³) and an increased C-reactive protein level (19.2 mg/dl). Computed tomography performed 2 days after admission revealed rapid growth of the aortic dissection. Blood cultures obtained upon admission were positive for Salmonella. Impending rupture of the aortic dissection complicated by Salmonella infection was strongly suspected, and the patient underwent emergency surgery consisting of debridement and prosthetic graft placement covered by an omental flap. In this case, it is believed that insidious Salmonella aortitis caused acute type B aortic dissection.     

ASYMPTOMATIC ANEURYSM OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY: REPORT OF A CASE

A rare case of saccular aneurysm of the right internal carotid artery is presented. The patient was asymptomatic, and the aneurysm was discovered incidentally at examination alter a fall. The diagnosis was confirmed angiographically, and the aneurysm was surgically excised with end-to-end anastomosis of the artery.     

Spontaneous rupture of the spleen caused by a <Emphasis Type="Italic">Bacillus</Emphasis> infection: Report of a case

We report a case of spontaneous splenic rupture (SSR) caused by a Bacillus species (sp.) infection. A 36-year-old man on warfarin therapy since an aortic valve replacement at the age of 13 was admitted to our hospital with a 3-week history of a high fever. He had been asymptomatic until 4 months previously, when he suffered a cerebral embolism despite adequate oral anticoagulation. Abdominal computed tomography revealed splenic infarctions, which resulted in splenic rupture 2 days later. After embolization of the splenic artery, splenectomy was successfully performed. Pathologic examination revealed splenic infarction, resulting from septic emboli, with associated rupture of the splenic capsule, but no abscess was found. Bacillus sp. was isolated from cultures of arterial blood preoperatively, and the excised splenic specimens, postoperatively. In addition to rupture of the suppurating intrasplenic vessels with hematoma formation, the anticoagulant therapy possibly contributed to distension of the intrasplenic hematoma.     

Dural arteriovenous malformation with false aneurysm and exophthalmos

Summary A case of dural arteriovenous malformation with giant non-traumatic false aneurysm in the left middle fossa is reported.A 10-year-old female patient was admitted to our hospital with pulsating exophthalmos of the left eye, which was successfully treated by ligation of the main feeder and finally by the radical excision of the dural AVM and false aneurysm. False aneurysm of non-traumatic origin is so rare that only two cases were detected in the literature (Reinaet al., Sakakiet al.), and no previous case of false aneurysm complicated by dural AVM seems to have been reported.Presented in part at the 82nd Regular Meeting of the Hirosaki Medical Society, Hirosaki, Japan, 15. December 1975.     

Endoluminal repair of internal carotid artery aneurysm: A feasible but hazardous procedure

Purpose: The aim of this study was to report the repair of an aneurysm of the internal carotid artery using the endoluminal method. Methods: A 70-year-old male patient noted a swelling in the right side of his neck 22 years after endarterectomy of the right internal carotid artery. Duplex ultrasound confirmed the clinical diagnosis of aneurysm of the internal carotid artery. Further investigation included contrast-enhanced computed tomographic (CT) scanning and carotid angiography performed via a retrograde femoral approach. The aneurysm contained thrombus and was 3 cm in diameter and in length. It extended superiorly from a point 0.5 cm above the carotid bifurcation to a point estimated to be 2 cm from the base of the skull. Repair of the aneurysm was undertaken using the endoluminal method. A self-expanding endograft 8 mm in diameter and 4 cm in length was introduced through a 12F sheath in the common carotid artery. An on-table completion angiogram of the right-sided extracranial carotid arteries and the intracranial internal carotid artery and branches was obtained. Results: The completion angiogram and postoperative CT scan confirmed exclusion of the aneurysm sac from the circulation. The patient awoke from anesthesia with complete paralysis of the left arm. Recovery of movement commenced 1 hour later. A brain CT scan demonstrated the event to be an embolic stroke. Strength had returned by 7 days. Function of the arm was good 1 month after operation, but coordination for fine movements was lacking. At the 6-month follow-up, good arm function was maintained. A duplex ultrasound scan demonstrated not only continued exclusion of the aneurysm sac but occlusion of the endograft, also. Conclusions: Endoluminal repair of aneurysms of the internal carotid artery is feasible but carries the risk of major morbidity as a result of peripheral embolization and early occlusion of the endograft. (J Vasc Surg 1997;26:1055-60.)     

Dissecting aneurysm of the posterior inferior cerebellar artery; a case report]

A case of a dissecting aneurysm of the left posterior inferior cerebellar artery caused by giant cell angiitis is presented. A 22-year-old woman was admitted on August 30, 1990, with sudden onset of severe occipital headache and vomiting. Neurological examination on admission only showed severe meningismus. CT scan demonstrated subarachnoid hemorrhage and a small hematoma in the 4th ventricle. A left vertebral angiogram demonstrated that the left posterior inferior cerebellar artery was occluded at the lateral medullary segment. We diagnosed subarachnoid hemorrhage from a dissecting aneurysm. On the day following admission, the patient underwent a left suboccipital craniectomy. The posterior inferior cerebellar artery was enlarged for a distance of about 8 mm and there was typical purplish-red appearance in the dissecting aneurysm. This aneurysm was excised after trapping. The histological diagnosis was primary localized giant cell angiitis without systemic involvement. The etiology of the intracranial dissecting aneurysm is obscure, but this report suggests that cerebral angiitis can be considered as an important factor.     

Ruptured Abdominal Aortic Aneurysms due to <Emphasis Type="Italic">Salmonella</Emphasis>, not of <Emphasis Type="Italic">typhi</Emphasis> Species

Ruptured aortic aneurysms due to Salmonella not of typhi species are rare and associated with high morbidity and mortality. We present three patients with Salmonella-infected ruptured aortic aneurysms successfully treated with an in situ prosthetic bypass graft. One patient had a saccular aneurysm at the infrarenal aorta and two patients had fusiform aneurysms at the aortic bifurcation. All the patients were treated with wide debridement of the infected aortic tissue followed by in situ graft replacement and long-term systemic antibiotic therapy. The method of revascularization, in situ bypass or extraanatomic bypass, remains controversial. On the basis of our clinical experience and recent literature focusing on more than 10 cases, in situ bypass reconstruction may be a feasible surgical technique for Salmonella-infected ruptured aortic aneurysm.     

True digital artery aneurysm of the ring finger: a case report

True aneurysms of the digital artery are very rare. Only 13 cases, caused by chronic trauma from occupational or sports-related overuse, have been reported. We present the first case of a true aneurysm of the digital artery of the left ring finger caused by chronic repetitive trauma from a wedding ring. The patient was a 44-year-old teacher who presented with a 1.5-cm subcutaneous mass on the radial aspect of the proximal phalanx of the finger, just proximal to the proximal interphalangeal joint. Exploration of the mass revealed a 1-cm aneurysm continuous with the radial digital artery. The aneurysm was excised and the proximal and distal ends of the radial digital artery ligated. Microscopic examination of the excised specimen confirmed the diagnosis of a true aneurysm with the lumen filled with an organising thrombus. The patient had an uneventful recovery with good wound healing, intact sensation, and normal capillary return.