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1.
Article in Japanese | WPRIM | ID: wpr-924587

ABSTRACT

A 49-year-old female with ruptured left common iliac mycotic arterial aneurysm (Lt. CIAA) was brought to our hospital as an emergency case. In Japan, endovascular treatment is unsuitable for the treatment of mycotic aneurysms, but findings from a Swedish national database showed that there was no difference in the long-term prognosis lasting over 10 years. Therefore, we performed endovascular aortic repair (EVAR) and saved the patient's life. The diameter of the proxymal sealing zone was larger than that of the distal zone. We used the Gore Excluder leg, which was inverted and implanted to match the caliber. Percutaneous abscess drainage was also performed on postoperative day 7 when hemostasis was confirmed for early infection control. The patient was discharged at 8 weeks postoperatively. After discharge from the hospital, oral antibiotics were continued until 6 months after the surgery. Six months postoperatively, contrast-enhanced computed tomography showed that the abscesses have disappeared. Blood samples that were taken at one month after the completion of antibiotics showed no evidence of the recurrence of infection and a curative course was achieved.

2.
J. vasc. bras ; 20: e20210122, 2021. graf
Article in English | LILACS | ID: biblio-1351011

ABSTRACT

Abstract Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa. Candida albicans was isolated from the culture of the excised aneurysm wall. An infected aortic aneurysm due to Candida has not been previously reported in a patient with malignant otitis externa. This case report aims to highlight that Candida should be suspected as a cause of infected aortic aneurysms in patients with debilitation and chronic immunosuppression. Management of such cases can be extremely challenging, especially in resource-poor settings, and we will be touching upon the advantages and disadvantages of various treatment options.


Resumo A cândida é uma causa rara de aneurismas da aorta infecciosos. Relatamos o caso de um paciente diabético com doença renal terminal, que foi submetido a reparo de aneurisma da aorta abdominal com vazamento. Ele estava em tratamento de longo prazo com antibióticos para otite externa maligna. A Candida albicans foi isolada da cultura da parede do aneurisma que sofreu a excisão. Não há relatos prévios de aneurisma da aorta infeccioso causado por cândida em pacientes com otite externa maligna. Este relato de caso visa reforçar que a cândida deve ser uma das suspeitas de causa de aneurisma da aorta infeccioso em pacientes debilitados e com imunossupressão crônica. O manejo desses casos pode ser extremamente desafiador, principalmente em contextos em que os recursos são escassos, e mencionaremos as vantagens e desvantagens das diversas opções de tratamento.


Subject(s)
Humans , Male , Aged , Otitis Externa/complications , Aneurysm, Infected/complications , Aortic Aneurysm, Abdominal/complications , Aneurysm, Infected/etiology , Candida albicans/pathogenicity , Aortic Aneurysm, Abdominal/therapy , Immune Tolerance/immunology , Anti-Bacterial Agents/adverse effects
3.
Article in Japanese | WPRIM | ID: wpr-837418

ABSTRACT

Background : Fungal mycotic aneurysm is rare ; however, special care and treatment are required for the deep fungal infection itself. Case : The patient was a 69-year-old man with a history of sepsis due to Candida albicans. He suffered from back pain and moderate fever. CT revealed saccular-form aneurysm at the infrarenal abdominal aorta. After emergent in situ bifurcated graft replacement of the infected aneurysm, antifungal treatment was attempted in reference to the antifungal drug sensitivity of C. albicans from intraoperative cultures and findings of fungal endophthalmitis in an ophthalmic examination. After an uneventful acute course, follow up CT images after 12 months postoperatively revealed pseudoaneurysm formation proximal to the site of graft anastomosis. Reoperation was planned with a trans-thoracic and transabdominal approach because of concerns about thoracoabdominal aortic infection. However, the reoperation displayed only inflammatory tissue around the graft and aortic tissue. Removal of the previous graft and reconstruction of the bilateral renal artery, and the pararenal abdominal aorta to the bilateral common iliac artery was performed. Intraoperative tissue cultures revealed no evidence of microorganisms. He returned home with oral antifungal treatment and is doing well at 8 months after the reoperation. Conclusions : Management of fungal mycotic aneurysms requires both surgical treatment and antifungal treatment. Antifungal agents should be selected based on the results of a susceptibility test and after examinations for metastatic comorbidities.

4.
Article in Japanese | WPRIM | ID: wpr-738315

ABSTRACT

We report a case of mycotic aneurysm treated with endovascular aneurysm repair (EVAR). An 80-year-old man was admitted to a local hospital with high fever and lower back pain. Pyogenic spondylitis and psoas muscle abscess were diagnosed. Klebsiella pneumoniae was confirmed by blood culture. Treatment with intravenous antibiotics was not effective and contrast computed tomography (CT) scan showed an enlargement of the abscess and an abdominal aortic rupture. The patient was immediately transferred to our hospital. Laboratory tests showed an elevated C-reactive protein (12.3 mg/dl) and WBC (10,400/μl). Mycotic abdominal aneurysm rupture was diagnosed by CT scan. He underwent an emergency EVAR with an Excluder® (aorta extender). Intraoperative angiography showed a ruptured abdominal aorta. After operation, he was treated with intravenous minocycline and ampicillin, and the size of the abscess reduced without any endoleak on enhanced CT imaging. After intravenous antibiotics therapy for 4 weeks, we switched to oral antibiotics (minocycline and ciprofloxacin) and continued them for 6 months. As of 2 years after the surgery, there are no signs of infection or recurrence.

5.
Article in English | WPRIM | ID: wpr-742467

ABSTRACT

Mycotic aneurysms of the common carotid artery (CCA) are very rare and warrant surgical treatment to prevent rupture and death. A 89-year-old man who complained of a sore throat and swelling of the right side of neck. He had no history of trauma or neck infection. Physical examination revealed hard and pulsatile mass. Computed tomography showed initially pseudoaneurysm rupture on the right CCA with surrounding inflammation. The emergency operation revealed mycotic aneurysm rupture with CCA necrosis and was successfully done by wide debridement and carotid artery resection with interposition bypass. The resected tissue and blood culture grew growth of Staphylococcus aureus group. We report a rare case of mycotic aneurysm of right CCA that treated by bypass interposition.


Subject(s)
Aged, 80 and over , Aneurysm, False , Aneurysm, Infected , Carotid Arteries , Carotid Artery, Common , Debridement , Emergencies , Humans , Inflammation , Neck , Necrosis , Pharyngitis , Physical Examination , Rupture , Staphylococcus aureus
6.
Article in Japanese | WPRIM | ID: wpr-378638

ABSTRACT

<p>A 23-year-old woman with mitral valve infective endocarditis complicated by embolism of the right common iliac artery underwent transfemoral embolectomy by a Fogarty catheter and mitral valve replacement. She developed occlusion of the right internal iliac artery, that was revealed by computed tomography on the 9th postoperative day. The occlusion was considered to result from migration of a part of the emboli from the right common iliac artery into the right internal iliac artery during the procedure of embolectomy. On the 16th postoperative day, she underwent repeat mitral valve replacement because of perivalvular leakage. Furthermore, after 2 weeks from the diagnosis of embolism of the right internal iliac artery, the embolic site showed aneurysmal formation finally requiring aneurysmectomy. Her recovery was uneventful. Our case is considered to be rare in that serial observations on computed tomography indicated the development of mycotic aneurysm at the site of septic embolism. In addition, care must be taken to prevent migration of emboli into branched arteries during the procedure of embolectomy for peripheral arterial septic embolism caused by infective endocarditis.</p>

7.
Article in English | WPRIM | ID: wpr-630706

ABSTRACT

Background: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair. Methods: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined. Results: The average age was 59.1 years (range 36-77). Comorbidities include hypertension, diabetes mellitus, tuberculosis, prior infection and previous open aneurysmal repair. All patients had raised WBC (>10.0x109 /L), ESR or Creactive protein on admission while 50% of patients had fever. Blood cultures were positive in 4 patients. All patients were given antibiotics. Only one in-hospital mortality was noted at day-47 post-procedure. Two patients died of aortoenteric fistula at district hospital eight and 16 months later. One patient died of chronic graft infection two years later. One died of unrelated cause. One patient developed type IB endoleak from internal iliac artery two years later and surgical ligation was performed. The average follow up was 15.8 months. Conclusion: Endovascular stent graft repair for pseudoaneurysm is a viable option compared to open surgery. It is less invasive, has lower operative morbidity and fair outcomes. However, some cases may be due to inflammatory aortitis instead of infective pseudoaneurysm, given the frequent culture-negative results. In order to obtain high yield of bacteria culture for infected pseudoaneurysm, open repair with tissue culture is still the main mode of treatment especially for patients with low comorbidity.


Subject(s)
Aneurysm, False
8.
Article in Korean | WPRIM | ID: wpr-133673

ABSTRACT

Mucormycosis is a rare opportunistic infection caused by fungi of the order Mucorales that typically occurs in patients with diabetes or immunocompromised state. Rhino-orbital-cerebral mucormycosis is the most common type, often has a life-threatening outcome. Mucormycosis has specific vascular tropism complicating mucorthrombosis or mycotic aneurysm. We report a diabetic patient presenting with ophthalmoplegia, orbital necrosis, and contralateral hemiparesis, who suddenly progressed to coma and died of subarachnoid hemorrhage due to the rupture of mycotic aneurysm in distal internal carotid artery.


Subject(s)
Aneurysm, Infected , Carotid Artery, Internal , Coma , Fungi , Humans , Mucorales , Mucormycosis , Necrosis , Ophthalmoplegia , Opportunistic Infections , Orbit , Paresis , Rupture , Subarachnoid Hemorrhage , Thrombosis , Tropism
9.
Article in Korean | WPRIM | ID: wpr-133672

ABSTRACT

Mucormycosis is a rare opportunistic infection caused by fungi of the order Mucorales that typically occurs in patients with diabetes or immunocompromised state. Rhino-orbital-cerebral mucormycosis is the most common type, often has a life-threatening outcome. Mucormycosis has specific vascular tropism complicating mucorthrombosis or mycotic aneurysm. We report a diabetic patient presenting with ophthalmoplegia, orbital necrosis, and contralateral hemiparesis, who suddenly progressed to coma and died of subarachnoid hemorrhage due to the rupture of mycotic aneurysm in distal internal carotid artery.


Subject(s)
Aneurysm, Infected , Carotid Artery, Internal , Coma , Fungi , Humans , Mucorales , Mucormycosis , Necrosis , Ophthalmoplegia , Opportunistic Infections , Orbit , Paresis , Rupture , Subarachnoid Hemorrhage , Thrombosis , Tropism
11.
Article in English | WPRIM | ID: wpr-54472

ABSTRACT

Mycotic aneurysms are rare inflammatory neurovascular lesions. Ruptured mycotic aneurysm manifesting as subdural hematoma is extremely rare. A 72-year-old male patient was admitted to our hospital with headache and drowsiness. Computer tomography (CT) of brain and CT angiography revealed subdural hematoma and an aneurysm located at the M4 segment of the left middle cerebral artery (MCA). Cerebral angiogram revealed 2 aneurysms; one located at the left distal MCA and the other at the bifurcation of left MCA. Laboratory studies showed leukocytosis and elevated inflammatory factors. The patent was treated with antibiotic therapy for 4 weeks. The follow-up CT and cerebral angiography showed that the mycotic aneurysm was completely resolved, and the patient was nearly free of symptoms.


Subject(s)
Aged , Aneurysm , Aneurysm, Infected , Angiography , Brain , Cerebral Angiography , Follow-Up Studies , Headache , Hematoma, Subdural , Humans , Leukocytosis , Male , Middle Cerebral Artery , Sleep Stages
12.
Article in English | IMSEAR | ID: sea-168243

ABSTRACT

The term mycotic aneurysm refers to aneurysm associated with infection by microorganism. Sir William Osler first coined the term mycotic aneurysm in 1885 by disclosing the relation between abnormal cardiac valves and infection with micrococci not with fungi. An 11 years old female from Feni presented with asymptomatic vascular swelling in abdomen referred by a cardiologist. CT angiogram revealed fusiform aneurysm in distal part of abdominal aorta involving ostioproximal part of both common iliac arteries and saccular aneurysm of distal part of superior mesenteric arteries suggestive of mycotic aneurysm. Patient underwent vascular operation aorto biilliac bypass by PTFE graft with excision and ligation of aneurysm of superior mesenteric arteries .Mycotic aneurysm in bacterial endocarditis is rare. It is a challenging job for the cardiologists, infectious disease specialists and vascular surgeon. Time appropriate skilled prompt surgical management can bring smile for both patients and physicians.

13.
Article in Japanese | WPRIM | ID: wpr-362937

ABSTRACT

A 69-year-old man with histories of cardiac and abdominal operations was hospitalized in another hospital due to brain contusion. Due to hemorrhage from the distal descending thoracic aorta, he was transferred to our hospital. After a diagnosis rupture of mycotic aneurysm an urgent operation was performed. The aneurysm was replaced by an <i>in situ </i>graft. For infection control, the graft was wrapped tightly by a pedicled latissimus dorsi muscle flap. Postoperatively, local infection of the muscle-dissected cavity continued. Although his life was ultimately not saved, he was able to live a comfortable hospital life with some activity for 8 months.

14.
Yonsei Medical Journal ; : 224-227, 2012.
Article in English | WPRIM | ID: wpr-145827

ABSTRACT

We report herein a case successful endovascular treatment with a stent-graft of a rare case of rapidly growing mycotic aneurysm of the left common carotid artery due to acute bacterial endocarditis after eradication of the infection. Infected mycotic aneurysms of the peripheral vasculature have been considered as a contraindication for stent-graft implantation because of the possibility of microorganism spreading to the stent-graft; however, if there is evidence of complete eradication of microorganism and surgery is not an option, stent-graft implantation can be an effective and safe treatment modality for exclusion of the mycotic aneurysm.


Subject(s)
Acute Disease , Aged, 80 and over , Aneurysm, Infected/etiology , Angioplasty/methods , Carotid Artery Diseases/etiology , Endocarditis, Bacterial/complications , Female , Humans , Stents , Treatment Outcome
15.
Article in English | WPRIM | ID: wpr-726654

ABSTRACT

There were many reports of infected pseudoaneurysms of the forearm that are caused by arterial injury or cannulation. However, spontaneous pseudoaneurysm of forearm artery without any history of arterial injury or cannulation is rare. Here, we report the case of an infected pseudoaneurysm in the forearm after infective endocarditis, without arterial injury or cannulation. A 76-year old man had a large, growing, pulsatile mass of the radial artery after experiencing infective endocarditis. We performed an interposition with great saphenous vein graft after removing the aneurysm. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis and treatment of pain in the extremity and swelling after infective endocarditis.


Subject(s)
Aneurysm , Aneurysm, False , Aneurysm, Infected , Arteries , Catheterization , Diagnosis, Differential , Endocarditis , Extremities , Forearm , Radial Artery , Saphenous Vein , Transplants
16.
Article in English | WPRIM | ID: wpr-18684

ABSTRACT

Mycotic aneurysm is a disease requiring immediate treatment because of the high risk of rupture. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extra-anatomic bypass grafting, is known to be a suitable treatment. We performed extra-anatomic bypass grafting after endovascular embolization successfully in two patients. The postoperative computed tomography of both patients showed complete exclusion of the mycotic aneurysm.


Subject(s)
Aneurysm, Infected , Humans , Iliac Artery , Rupture , Transplants
17.
Article in Korean | WPRIM | ID: wpr-202164

ABSTRACT

PURPOSE: To report a case of mycotic aneurysm of the cerebral basilar artery associated with bilateral endogenous aspergillus endophthalmitis. CASE SUMMARY: A 41-year-old man with no underlying disease presented with decreased vision in both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis, and the authors performed a vitrectomy and lensectomy on the right eye. Hyphae were detected in the vitreous sample, and systemic amphotericin was administered. Three days after the operation, the patient became comatose due to a subarachnoid hemorrhage. Aspergillus antigen was detected in the vitreous sample and in the cerebrospinal fluid. Subarachnoid hemorrhage was due to the rupture of a mycotic aneurysm of the cranial basilar artery, complicated by aspergillus infection of the central nervous system.


Subject(s)
Adult , Amphotericin B , Aneurysm, Infected , Aspergillus , Basilar Artery , Central Nervous System , Coma , Endophthalmitis , Eye , Humans , Hyphae , Rupture , Subarachnoid Hemorrhage , Vision, Ocular , Vitrectomy
18.
Article in English | WPRIM | ID: wpr-62449

ABSTRACT

A 62-year-old woman has been suffered from cavernous sinus thrombophlebitis which was confirmed by four-vessel angiography, orbit magnetic resonance imaging, and blood culture. Three weeks after recovery of cavernous sinus thrombophlebitis, right eye proptosis and complete third, fourth, and sixth cranial nerve palsies developed. Best-corrected visual acuity decreased to 20/70 in the right eye. Repeat magnetic resonance imaging demonstrated a 1.5-cm-sized mass in the right cavernous sinus, suspicious for mycotic aneurysm. Amphotericin B supplementation was begun and was followed by successful transarterial Guglielmi detachable coil embolization. Four months later, extraocular movement was normalized, and visual acuity improved to 20/25 in the right eye.


Subject(s)
Amphotericin B/therapeutic use , Aneurysm, Infected/etiology , Angiography , Antifungal Agents/therapeutic use , Cavernous Sinus Thrombosis/complications , Embolization, Therapeutic/methods , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Visual Acuity
19.
Infection and Chemotherapy ; : 369-374, 2010.
Article in Korean | WPRIM | ID: wpr-11011

ABSTRACT

Intracranial mycotic aneurysm (IMA) is rare, but life-threatening cerebrovascular lesion, which arises from a variety of primary infection foci such as infective endocarditis, bacterial meningitis, cavernous sinus thrombophlebitis, etc. The diagnosis of IMA usually depends on the documentation of an intracranial aneurysm by vascular imaging in the presence of primary infection foci. As the gold standard for detecting IMA, high-tech computed tomography will eventually replace cerebral angiography. Because of the lack of prospective cohorts and randomized controlled trials, there is no widely accepted treatment guideline for IMA. With recent advances in surgical technique and the introduction of endovascular therapy, however, clinical outcome of patients with IMA tends to improve. This review will provide the state-of-the-art knowledge on clinical aspect and treatment strategy of IMA.


Subject(s)
Cavernous Sinus Thrombosis , Cerebral Angiography , Cohort Studies , Endocarditis , Humans , Intracranial Aneurysm , Meningitis, Bacterial
20.
Korean Journal of Medicine ; : 357-363, 2010.
Article in Korean | WPRIM | ID: wpr-224545

ABSTRACT

A mycotic aneurysm is a localized, irreversible arterial dilatation resulting from destruction of the vessel wall by infection. Pathogens causing mycotic aneurysms include Gram-positive and -negative bacteria, mycobacteria, and fungi. Klebsiella pneumoniae is a common pathogen causing urinary tract infections, nosocomial pneumonia, soft tissue infection, pyogenic liver abscesses, and endophthalmitis, while mycotic aneurysms caused by K. pneumoniae are rare. Recently, the number of cases of endogenous K. pneumoniae endophthalmitis associated with K. pneumoniae-induced pyogenic liver abscesses has increased in Southern Asia, but there have been no reports of K. pneumoniae mycotic aneurysms accompanied by endophthalmitis. Here, we report the case of a man who had a K. pneumoniae mycotic aneurysm accompanied by endophthalmitis and, ultimately, lost sight in both eyes. The early diagnosis of associated endophthalmitis requires a high index of suspicion by the physician.


Subject(s)
Aneurysm, Infected , Aorta , Asia , Bacteria , Dilatation , Early Diagnosis , Endophthalmitis , Eye , Fungi , Glycosaminoglycans , Klebsiella , Klebsiella pneumoniae , Liver Abscess, Pyogenic , Pneumonia , Soft Tissue Infections , Urinary Tract Infections
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