Introduction: Clostridium septicum (C. septicum) aortitis is a rare condition frequently associated with colon adenocarcinoma and carries a poor prognosis. Case Report: We report the case of an 80-year-old man who was waiting for an elective endovascular repair of an abdominal aortic aneurysm (AAA) with a diameter of 5.8 × 5.4 cm. He underwent a colonoscopy because of a thickening of the colon wall in the preoperatory CT. One week after that, he presented at the emergency with a 48-hour duration of fever and abdominal pain. Abdominal CT imaging revealed an increased aneurysm size to 6.1 × 6.6 cm including gas within the aorta. Treatment consisted of antibiotics, urgent axillar to femoro-femoral bypass, excision and ligation of the infrarenal aorta and right hemicolectomy with end-ileostomy. Aortic cultures were positive for C. septicum. The postoperative was complicated by renal failure and the patient died. Conclusion: C. septicum-infected aortic aneurysm is a rare entity that is strongly associated with colon cancer. The presence of gas within the aorta or emphysematous aortitis is the most common sign of C. septicum infection. Broad-spectrum antibiotics should be initiated and emergency surgical management with excision of the infected aneurysm and grafting is required.

Carotid artery disease has traditionally been assessed based on the degree of luminal narrowing. However, this approach, which solely relies on carotid stenosis, is currently being questioned with regard to modern risk stratification approaches. Recent guidelines have introduced the concept of the “vulnerable plaque,” emphasizing specific features such as thin fibrous caps, large lipid cores, intraplaque hemorrhage, plaque rupture, macrophage infiltration, and neovascularization. In this context, imaging-based biomarkers have emerged as valuable tools for identifying higher-risk patients. Non-invasive imaging modalities and intravascular techniques, including ultrasound, computed tomography, magnetic resonance imaging, intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy, have played pivotal roles in characterizing and detecting unstable carotid plaques. The aim of this review is to provide an overview of the evolving understanding of carotid artery disease and highlight the significance of imaging techniques in assessing plaque vulnerability and informing clinical decision-making.

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