Anévrismes infectieux de l’aorte thoracique : présentation de 7 cas et revue de la littérature |
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Authors: | S. Roux,T. Ferry,C. Chidiac,A. Bouaziz,J. Ninet,L. Pé rard,F. Farhat,C. Broussolle,P. Sè ve |
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Affiliation: | 1. Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France;2. Service de maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France;3. Service de médecine interne, hôpital Édouard-Herriot, 5, place d’Arsonval, 69437 Lyon, France;4. Chirurgie cardiaque, thoracique et vasculaire, hôpital Louis-Pradel, 28, avenue du Doyen-Jean Lépine, 69500 Bron, France |
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Abstract: | PurposeInfectious aortic aneurysms are rare conditions, being responsible of 2% of aortic aneurysms. Most published results are surgical case series concerning infected abdominal aorta. In this retrospective study, we assessed clinical features and outcome of patients presenting infectious thoracic aortic aneurysms.Patients and methodsDiagnosis was based upon a combination of imaging evidence for thoracic aorta aneurysm and evidence for an infective aetiology including a culture of a causative pathogen, or a favourable outcome with anti-infective therapy. Retrospective case series.ResultsSix men and one woman were included, with a mean age of 66 years. All the patient presented at least one cardiovascular risk factor or atherosclerosis localisation. Fever (71%) and chest pain (42%) were the most common clinical presenting manifestations. The causative pathogens were: Staphylococcus aureus (N = 1), Salmonella enteritidis (N = 3) and Candida albicans (N = 1). The contrast-enhanced computed-tomography disclosed an aneurysm whose diameter reached more than 50 mm (N = 5), that increased rapidly in size (N = 5), or presented an inflammatory aspect of the aortic wall (N = 4). Management was both medical and interventional: surgery (N = 3) or endoluminal repair (N = 4). Outcome was favourable in six patients; one patient died from aneurysm-related complications.ConclusionClinical manifestations revealing an infectious thoracic aneurysm are variable. Diagnosis should be considered in patients presenting a rapidly-growing aneurysm, especially in the presence of elevated acute phase reactants. Endoluminal repair constitutes a treatment option. The role of FDG-PET for diagnosis and follow-up remains to be defined. |
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Keywords: | Aorte thoracique Ané vrisme Infection Traitement endovasculaire |
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