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1.
Cardiovasc Pathol ; 44: 107152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31760245

RESUMO

A 74-year-old woman with severe aortic valve stenosis underwent aortic valve replacement with a pericardial bioprosthesis. Histological analysis of the excised valve showed dystrophic calcification associated with signs of healed infective endocarditis. Two months later, the patient died due to congestive heart failure. Autopsy revealed a bowel infarction and the presence of multiple mycotic aneurysms of the aortic root with mural thrombosis, which were unnoticed during the patient hospital stay and surgical window.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma Aórtico/microbiologia , Estenose da Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Idoso , Aneurisma Infectado/patologia , Aneurisma Infectado/terapia , Aneurisma Aórtico/patologia , Aneurisma Aórtico/terapia , Autopsia , Causas de Morte , Evolução Fatal , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Infecções por Klebsiella/patologia , Infecções por Klebsiella/terapia , Infecções Relacionadas à Prótese/patologia , Infecções Relacionadas à Prótese/terapia
2.
BMC Infect Dis ; 19(1): 959, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711418

RESUMO

BACKGROUND: An infected aneurysm of the thoracic aorta is a rare clinical condition with significant morbidity and mortality. Patients with fast-growing aortic aneurysms show a high incidence of rupture. Gram-positive organisms, such as the Staphylococcus and Enterococcus species, are the most common cause of infection. CASE PRESENTATION: A 91-year-old man presented at our facility with high grade fever and tachypnea, which he had experienced for the previous two days. He had a history of end-stage renal disease and had been undergoing regular chest computed tomography (CT) follow-up for a left lower lung nodule. CT imaging with intravenous contrast media showed a thoracic aortic aneurysm with hemothorax. Rupture of the aneurysm was suspected. CT imaging performed a year ago showed a normal aorta. Blood samples showed a Bacillus cereus infection. The patient was successfully treated for a mycotic aortic aneurysm secondary to Bacillus cereus bacteremia. CONCLUSIONS: Here, we report a rare of an infected aneurysm of the thoracic aorta probably caused by Bacillus cereus. Although infected aneurysms have been described well before, an aneurysm infected with Bacillus cereus is rare. Bacillus cereus, a gram-positive spore-building bacterium, can produce biofilms, which attach to catheters. It has recently emerged as a new organism that can cause serious infection.


Assuntos
Aneurisma Infectado/microbiologia , Aorta Torácica/microbiologia , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Bacillus cereus/isolamento & purificação , Administração Intravenosa , Administração Oral , Idoso de 80 Anos ou mais , Aneurisma Infectado/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/uso terapêutico , Hemotórax/diagnóstico por imagem , Humanos , Masculino , Insuficiência Respiratória , Choque Séptico/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico
3.
J Radiol Case Rep ; 13(4): 17-27, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31565178

RESUMO

Mycotic pseudoaneurysms usually arise from an infectious arteritis or mycotic aneurysms secondary to weakening and destruction of the arterial wall resulting in a contained rupture. We report a case of a mycotic pseudoaneurysm affecting the aortic isthmus of the thoracic aorta which is an extremely rare infection. To our knowledge no case report of mycotic pseudoaneurysm of the aortic isthmus secondary to salmonella infection has thus far been described. The specific case we present is also unique in that it posed a diagnostic imaging dilemma where the initial imaging revealed a periaortic mass which could not be accurately characterized and only on subsequent imaging reveal itself to be a thrombosed mycotic pseudoaneurysm. We hope that our case report highlights to the medical community the high degree of suspicion one should have regarding pseudoaneurysms when dealing with a complex mass intimately related to a vascular structure.


Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Infecções por Salmonella/diagnóstico por imagem , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Aneurisma Infectado/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/microbiologia , Aortografia , Angiografia por Tomografia Computadorizada , Humanos , Masculino
4.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31624217

RESUMO

Mycotic pulmonary artery aneurysms (MPAAs) are rare and life-threatening with currently no recommended treatment strategies. In this report, we describe a successfully treated case of ventricular septal defect in an 11-month-old girl who developed bacteremia, infective endocarditis, and MPAA caused by methicillin-resistant Staphylococcus aureus (MRSA). We first started vancomycin, gentamycin, and panipenem-betamipron for infective endocarditis but switched to teicoplanin and arbekacin on day 3 after initiating treatment because bacteremia persisted, and vancomycin minimum inhibitory concentration was relatively high at 2 mg/L. Although we added clindamycin on day 5 and fosfomycin on day 7, MRSA bacteremia persisted, and we finally added daptomycin at 10 mg/kg per day on day 8, whereupon the bacteremia subsided within a day. Although the bacteremia subsided, the patient developed septic pulmonary embolisms and septic arthritis on her left knee. We continued daptomycin but switched the concomitant drug to linezolid, trimethoprim-sulfamethoxazole, and rifampicin on day 11. After several repeats of puncture and lavage of her knee joint, she became afebrile on day 16. Computed tomography scans taken on day 32 revealed right pulmonary artery MPAAs. She was treated with long-term multidrug therapy, and MPAAs were absent on subsequent computed tomography scans on day 184. Multidrug therapy mainly based on daptomycin could be a possible salvage therapy for refractory MRSA bacteremia with high vancomycin minimum inhibitory concentration. Conservative treatment should be selectively considered as a treatment option for clinically stable MPAA instead of surgical and endovascular treatment.


Assuntos
Aneurisma Infectado/tratamento farmacológico , Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Artéria Pulmonar/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Clindamicina/uso terapêutico , Tratamento Conservador , Combinação de Medicamentos , Quimioterapia Combinada , Ecocardiografia , Feminino , Comunicação Interventricular/complicações , Humanos , Lactente , Linezolida/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Artéria Pulmonar/diagnóstico por imagem , Radiografia , Rifampina/uso terapêutico , Sulfametizol/uso terapêutico , Trimetoprima/uso terapêutico
5.
Semin Vasc Surg ; 32(1-2): 68-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540659

RESUMO

The management of infection involving the abdominal aorta requires clinical decisions based on patient factors and the nature of the infectious process. Any infection occurring after endovascular aortic aneurysm repair or open aortic replacement grafting should be treated promptly with appropriate systemic antibiotic therapy. Once a vascular prosthesis becomes infected, surgical treatment is necessary. There should be a low threshold for graft excision and extra-anatomic bypass in the presence of fistula or abscess cavity, when feasible entire graft should be excised. In selected patients, graft excision with in situ aorta reconstruction is an appropriate option using an autogenous femoral vein, cryopreserved allograft, or a prosthetic graft impregnated with antibiotic. The replaced in situ aortic graft should be covered with an omental pedicle. For primary aortic graft infections, endovascular treatment may act as a bridge to more definitive treatment; or, in the absence of gross retroperitoneal infections, endovascular grafting alone with prolonged systemic antibiotic therapy is a viable option, particularly in patients not fit for open surgical procedures.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Infecções Relacionadas à Prótese/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Implante de Prótese Vascular/instrumentação , Medicina Baseada em Evidências , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Fatores de Risco , Resultado do Tratamento
6.
Semin Vasc Surg ; 32(1-2): 73-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540660

RESUMO

The use of autologous femoral veins for in situ reconstruction of the aortoiliac segment is an effective technique to treat native aorta or prosthetic graft infections. The indications, technical details, and outcomes of this procedure are detailed. Graft infection involving the aortic segment, while rare, remains one of the most challenging vascular surgery conditions to treat. The original technique of "neo-aortoiliac surgery" with in situ autologous vein grafts has evolved over the past 25 years and remains a worthwhile alternative for the treatment of aortic graft infections, with lower mortality rates compared with other extra-anatomic or in situ surgical options. Acceptance of this surgical option is due to low graft re-infection rates, rare graft disruption, and low long-term aneurysmal degeneration. Excision of the femoral veins is associated with acceptable rates of lower limb edema. The use of an autologous femoral vein graft can be considered the standard of care in selected patients for the management of aortic graft infections. Optimal management of patients with aortic graft infections requires consideration of all potential therapeutic options because no single modality can be used, and individualizing treatment according to the clinical condition will yield the best patient outcomes.


Assuntos
Aneurisma Infectado/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Veia Femoral/transplante , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta/diagnóstico por imagem , Aorta/microbiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Remoção de Dispositivo , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Fatores de Risco , Resultado do Tratamento
7.
Pan Afr Med J ; 32: 157, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303927

RESUMO

Infectious endocarditis is regarded as a potentially serious pathology despite the advances in diagnostic and treatment options. Valves on the left side of the heart are most affected and embolic events, mycotic aneurysms, abscesses as well as valve perforations are life-threatening consequences of this disease. We here report a case of endocarditis with aortic and mitral valve involvement complicated by splenic and renal infarction, cerebral mycotic aneurysm and mitral valve perforation. The interest in the subject of this case study is the positive medico-surgical treatment outcome obtained despite a multitude of complications.


Assuntos
Valva Aórtica/microbiologia , Endocardite Bacteriana/diagnóstico , Aneurisma Cardíaco/diagnóstico , Valva Mitral/microbiologia , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Valva Aórtica/patologia , Endocardite Bacteriana/microbiologia , Aneurisma Cardíaco/microbiologia , Humanos , Masculino , Valva Mitral/patologia , Infarto do Baço/diagnóstico
8.
J Stroke Cerebrovasc Dis ; 28(7): e81-e82, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31101401

RESUMO

This is the first reported case in which a mycotic aneurysm refractory to the first medical treatment was treated with a Pipeline embolization device (PED), and the first case of a mycotic aneurysm from Brucella treated by endovascular therapy. A 35-year-old man presented with left eye pain and ptosis, and fever for 2 weeks. Before symptom onset, he visited Vietnam where he developed a flu-like illness; however, antibiotics were ineffective. We suspected Brucella as the most likely infectious etiology for the patient's intracavernous aneurysm. Since the aneurysm did not reduce in size following 2 weeks of antibiotic therapy, we placed a PED in the left internal carotid artery. Follow-up angiogram 4 months later showed no residual aneurysm, and cranial nerve palsies had completely resolved. From the results of this case, it appears that flow diverter stenting may be a safe and effective treatment of mycotic aneurysms of the cavernous segment of ICA.


Assuntos
Aneurisma Infectado/cirurgia , Brucelose/cirurgia , Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/fisiopatologia , Angiografia Digital , Antibacterianos/uso terapêutico , Brucelose/diagnóstico por imagem , Brucelose/microbiologia , Brucelose/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/microbiologia , Doenças das Artérias Carótidas/fisiopatologia , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/microbiologia , Aneurisma Intracraniano/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Desenho de Prótese , Resultado do Tratamento
10.
Ann Vasc Surg ; 60: 475.e11-475.e17, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075452

RESUMO

BACKGROUND: Streptococcus pneumoniae is considered a rare cause of mycotic aneurysms. The microbiological diagnosis of mycotic aneurysms can be difficult, and many patients have negative blood culture results. METHODS: We describe a series of four consecutive cases of mycotic aneurysms caused by S. pneumoniae with no respiratory features or extravascular septic foci. In two patients with negative blood culture results, 16S PCR was used for the diagnosis of S. pneumoniae infection. RESULTS: Four men with mycotic aneurysms affecting the aorta, axillary, and popliteal arteries caused by S. pneumoniae presented to our center between 2015 and 2016. All were treated with at least one month of intravenous antibiotics, followed by at least 4 weeks of oral antibiotics. Two were additionally managed using endovascular surgical techniques, and one underwent an open surgical repair. The fourth patient presented with bilateral popliteal aneurysms, one of which ruptured and was managed using surgical ligation and bypass, whereas the other side subsequently ruptured and was repaired endovascularly. Three of the four patients are currently off antibiotics and considered cured, while one died of an unrelated cause. CONCLUSIONS: S. pneumoniae should be considered a potential causative agent of mycotic aneurysms. Diagnosis can be confirmed using 16S PCR, especially in patients where peripheral blood cultures are uninformative.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma Roto/microbiologia , Aneurisma Aórtico/microbiologia , DNA Bacteriano/genética , Aneurisma Ilíaco/microbiologia , Infecções Pneumocócicas/microbiologia , Reação em Cadeia da Polimerase , Ribotipagem/métodos , Streptococcus pneumoniae/genética , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/terapia , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/terapia , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico , Valor Preditivo dos Testes , Streptococcus pneumoniae/isolamento & purificação , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
12.
BMJ Case Rep ; 12(5)2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31122956

RESUMO

Melioidosis is a protean disease which is endemic to Southeast Asia and northern Australia. Here, we report a case of infected aortic aneurysm due to Burkholderia pseudomallei in an immunocompetent man 6 months after a trip to northern Malaysia. This patient initially received inappropriate surgical and antibiotic treatment, leading to a peri-prosthetic aortic infection with lumbar spondylitis and contiguous psoas muscle abscess. This case highlights the difficulty of diagnosing melioidosis given its diverse clinical manifestations and the limits of routine microbiological methods to identify B. pseudomallei Melioidosis should be considered a possible diagnosis in individuals with unexplained fever subsequent to travel in an endemic area.


Assuntos
Aneurisma Infectado/diagnóstico , Burkholderia pseudomallei/isolamento & purificação , Melioidose/diagnóstico , Pielonefrite/diagnóstico , Artéria Renal , Viagem , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Humanos , Malásia , Masculino , Melioidose/complicações , Melioidose/diagnóstico por imagem , Melioidose/microbiologia , Pessoa de Meia-Idade , Pielonefrite/complicações , Pielonefrite/diagnóstico por imagem , Pielonefrite/microbiologia , Tomografia Computadorizada por Raios X
13.
J Med Vasc ; 44(3): 216-227, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31029278

RESUMO

Tuberculous aneurysms of the common iliac artery are rare. Only a few cases have been reported in the literature. We report a new case in a 47-year-old man admitted for abdominal pain and persistent fever. The aneurysm was evoked in the duplex ultrasound scan and confirmed by computed tomographic angiography. The patient underwent an extra-anatomic femorofemoral bypass with a dacron prosthesis and ligation of the aneurysmal artery. The postoperative course was marked by febrile dyspnea related to the tuberculous miliary found on the chest x-ray. Histological analysis of the operative specimens confirmed the tuberculous origin of the aneurysm. The patient was put on antituberculous drugs and the follow-up was uneventful. With a follow-up of four months, the patient was asymptomatic and the bypass was well patent.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Roto/cirurgia , Implante de Prótese Vascular , Aneurisma Ilíaco/cirurgia , Tuberculose Cardiovascular/microbiologia , Tuberculose Miliar/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/microbiologia , Antituberculosos/uso terapêutico , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/microbiologia , Ligadura , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose Cardiovascular/diagnóstico , Tuberculose Cardiovascular/tratamento farmacológico , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico
16.
Ann Vasc Surg ; 58: 326-330, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30731219

RESUMO

BACKGROUND: Arterial ligation has been described in the literature as a safe and effective procedure with a relatively low number of patients requiring major amputations. METHODS: We performed a retrospective analysis of a prospectively held database of all patients who underwent arterial ligation for infected femoral pseudoaneurysms due to chronic intravenous drug abuse from January 2012 to March 2018. Information recorded for each patient included age, gender, blood investigations, microbiologic results, diagnostic modality, operative details, outcome of surgery, postoperative complications, and follow-up. RESULTS: There were 25 patients identified, with 2 of them undergoing bilateral ligations. It was more common in men (4:1), and the mean age at presentation was 39.7 years (standard deviation 8.2 y). Nine patients underwent major limb amputation for severe limb ischemia (7 transfemoral amputations and two 53 hip disarticulation). Average hospital stay was 24 days, and there was no mortality. We found a trend with a higher level of arterial ligation, leading to a higher rate of amputation. CONCLUSIONS: Our study is the first to show that there is a trend toward a higher risk of amputation with a higher level of ligation in this cohort of patients, and therefore, we suggest avoidance of external iliac artery ligation even at the most distal part just under the ligament, leaving the circumflex iliac vessel in circuit. Arterial ligation also carries a higher risk of major amputation than previously reported.


Assuntos
Amputação , Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Artéria Femoral/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/microbiologia , Humanos , Tempo de Internação , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Fatores de Tempo , Resultado do Tratamento
17.
BMJ Case Rep ; 12(1)2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30700449

RESUMO

Basidiobolomycosis is a rare fungal infection that may affect the gastrointestinal tract. It is caused by Basidiobolus ranarum and less than 80 cases have been reported in the literature. The incidence seems to be higher in the Middle East and in particular Saudi Arabia where most cases are diagnosed in the south-western region. An 18-year-old woman presented to the emergency department with an obstructing caecal mass initially suspected to be malignant. Surgical resection was complicated by bowel perforation, histology and cultures confirmed basidiobolomycosis infection. The postoperative course was complicated by an enterocutaneous fistula, fungal intra-abdominal abscesses, liver and lung abscesses, formation of mycotic hepatic artery aneurysm and meningoencephalitis. The patient eventually expired due to sepsis despite aggressive treatment. Diagnosis and management of such rare cases are very challenging and require a multidisciplinary approach. Complications are common and associated with a high mortality.


Assuntos
Aneurisma Infectado/complicações , Neoplasias do Colo , Entomophthorales/isolamento & purificação , Obstrução Intestinal/complicações , Perfuração Intestinal/complicações , Zigomicose/complicações , Adolescente , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/microbiologia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Perfuração Intestinal/diagnóstico , Intestinos , Arábia Saudita , Sepse/complicações , Sepse/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Zigomicose/diagnóstico
18.
Ann Vasc Surg ; 59: 312.e1-312.e5, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30802574

RESUMO

BACKGROUND: Mycotic aortoiliac aneurysms in neonates are rare. Surgical treatment has traditionally been the standard of care, but recent case reports have suggested that endovascular management of mycotic iliac aneurysms may also be safe and effective. In this case, we describe successful management of a mycotic aortoiliac aneurysm in a neonate with exploratory laparotomy and ligation of the left common iliac artery. METHODS: A full-term infant boy of uncomplicated delivery was transferred to our institution on day 2 of life after a barium enema concerning for small left colon syndrome. An umbilical artery catheter had been placed for monitoring but was removed before transfer. During his hospital course, he developed left leg edema and fever. He was found to have a mycotic aneurysm of the left common and internal iliac arteries, causing common iliac venous compression. A repeat ultrasound revealed the aneurysm measured a maximum of 12 mm in diameter and 26 mm in length. RESULTS: Treatment was delayed until the patient was clinically stable. He was monitored with serial ultrasounds, which showed no significant increase in aneurysmal size. A review of the literature supported the perception the aneurysm posed an impending risk to the patient. On day 16 of life, the neonate underwent ligation and excision of the left common iliac artery aneurysm. CONCLUSION: Our experience found ligation of the common iliac artery to be safe and effective, establishing that surgical reconstruction is not required.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Ilíaco/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Angiografia por Tomografia Computadorizada , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/microbiologia , Recém-Nascido , Ligadura , Masculino , Resultado do Tratamento , Ultrassonografia Doppler em Cores
19.
Ann Vasc Surg ; 59: 311.e5-311.e9, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30802585

RESUMO

BACKGROUND: The objective of this report is to present a challenging case of a mycotic aneurysm of the innominate artery (IA) in a patient with a bovine aortic arch. MATERIALS AND METHODS: An 85-year-old woman presented with intermittent fever and positive blood cultures for Staphylococcus aureus. An echocardiogram and a positron emission tomography-computed tomography were performed, showing a hypermetabolic dilation of the IA compatible with a mycotic aneurysm with a type one bovine aortic arch. Conventional open arch repair and total endovascular repair with a custom-made aortic endograft were rejected given the elderly age and need for urgent repair. Treatment was achieved with a hybrid procedure, including a left carotid transposition and exclusion of the aneurysm with a modified Endurant II® iliac limb (two stents were cut off and it was resheathed in an inverted fashion) released through a prosthetic graft sutured onto the right axillary artery, followed by coil embolization of the sac. One year after the repair, the patient is well with complete exclusion of the aneurysm. CONCLUSIONS: Under the need for urgent repair, "on-the-table" modification of standard endograft components can be an effective solution for aneurysm exclusion when off-the-shelf endovascular stent grafts do not meet the anatomical requirements.


Assuntos
Aneurisma Infectado/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Tronco Braquiocefálico/cirurgia , Procedimentos Endovasculares/instrumentação , Infecções Estafilocócicas/cirurgia , Stents , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Angiografia Digital , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/microbiologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Desenho de Prótese , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento
20.
Ann Vasc Surg ; 59: 310.e7-310.e11, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30802589

RESUMO

BACKGROUND: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is an effective and widely used treatment for patients with in situ bladder cancer. Major complications are quite uncommon, but a systemic dissemination of the attenuated strain of Mycobacterium bovis is possible. Few cases of aortic rupture caused by M bovis infection are described in literature. METHODS: A 70-year-old male, treated 3 months before with BCG instillation, presented to the emergency department because of a ruptured abdominal aortic aneurysm. The patient was hemodynamically stable, with a "hostile" abdomen. Therefore, an Endologix AFX endograft was deployed. During the postoperative period, his blood inflammatory markers increased, suspicious of a graft infection. Single-photon emission computed tomography (CT)/CT scan showed aortic increased uptake. Antibiotic therapy was continued, but after some days, the patient presented with hematemesis, and the CT scan showed an aortoenteric fistula. In emergency, the infected graft and aneurysm were removed, enteric fistula was closed, and an axillobifemoral bypass was performed. The patient died 25 days after endovascular aneurysm repair explantation. RESULTS: Despite the high suspicion of mycotic aortic aneurysm and graft infection by M bovis, there is no proof of this theory because of the absence of any positive culture test. M bovis is a slow-growing bacteria, and specific culture tests are required to identify it; indeed, all our blood and intraoperative samples were positive to other bacteria, probably the contaminant ones. CONCLUSIONS: Mycotic aneurysm is an extremely rare complication of intravesical BCG therapy, but it must be taken into consideration in patients with rapidly growing aortic aneurysms or rupture of a normal aorta, who have been previously submitted to this kind of instillation.


Assuntos
Aneurisma Infectado/microbiologia , Antineoplásicos/efeitos adversos , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Vacina BCG/efeitos adversos , Mycobacterium bovis/patogenicidade , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Antineoplásicos/administração & dosagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Aortografia/métodos , Vacina BCG/administração & dosagem , Angiografia por Tomografia Computadorizada , Evolução Fatal , Humanos , Masculino , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
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