Rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm documented by transesophageal echocardiography

Wein, M.; Bartel, Thomas; Kabatnik, Martin; Sadony, V.; Dirsch, Olaf; Erbel, Raimund

doi:10.1067/mje.2001.111876

Cited by 27 publications

(15 citation statements)

References 14 publications

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“…2,14) Our patient was elderly and had a history of atherosclerotic disease, but was female and afebrile. Furthermore, her inflammatory markers were markedly elevated and she had leukocytosis with neutrophilia, but this was in the context of a diagnosis of community-acquired pneumonia and soon afterwards a urinary tract infection, both of which were at first felt to satisfactorily explain her laboratory abnormalities.…”

Section: Discussionmentioning

confidence: 97%

Infectious Aortitis

2016

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SummaryAortitis is broadly divided into infectious and non-infectious etiologies, each with distinct treatment implications. We present the case of a patient who sustained a type A aortic dissection during urgent coronary angiography for acute coronary syndrome. Clinical findings and events during the procedure raised suspicion for an underlying vascular disorder; however, the diagnosis of staphylococcal aortitis was not made until pathological examination of resected tissue. Clues to the diagnosis of infectious aortitis noted throughout the patient's clinical course are detailed as are potential consequences of diagnostic delays and treatment decisions, underscoring the difficulties in recognizing and managing the condition. In addition, we describe a previously unreported complication of cardiac catheterization in the setting of an infectious aortopathy. (Int Heart J 2016; 57: 645-648) Key words: Aortic dissection, Coronary angiography, Iatrogenic disease D ifficulties in diagnosing aortitis are compounded by the importance of differentiating between its infectious and non-infectious etiologies given their markedly divergent treatment implications.1) We describe a patient who underwent urgent coronary angiography that was complicated by iatrogenic type A aortic dissection (iAAD) requiring surgical intervention. Staphylococcus aureus aortitis was diagnosed on pathological examination. We emphasize the need for a high index of suspicion to accurately diagnose infectious aortitis (IA), review pitfalls in its recognition and management, and describe its previously unreported association and postulated contribution to iAAD during coronary angiography. Case ReportAn 83-year-old woman presented to hospital with polyarthralgia, muscle stiffness, and generalized weakness following a fall. She denied fevers or rigors, chest discomfort, or jaw claudication. Her medical history included stable angina with previous coronary angioplasty, hypertension, dyslipidemia, and hypothyroidism. Her exam was notable for bradycardia at 52 bpm, an oxygen saturation of 93% on 2 L/minute of oxygen via nasal cannula, mild jugular venous distention with unremarkable heart sounds and lung fields, and no peripheral edema. Investigations revealed neutrophilic leukocytosis (16.7 × 10 9 /L), acute kidney injury, and troponin I of 0.66 μg/L. Her erythrocyte sedimentation rate was elevated at 100 mm/h as was her C-reactive protein at > 190 mg/L. Chest x-ray demonstrated a left lower lobe consolidation. Cefuroxime and doxycycline were initiated and the patient was admitted to hospital with a diagnosis of community-acquired pneumonia. Urine cultures grew methicillin-sensitive S. aureus (MSSA), prompting the medical team to change her antibiotics to intravenous ceftriaxone, but repeated blood cultures were negative.On her third day in hospital, the patient developed severe retrosternal chest pain and diaphoresis. Her ECG demonstrated new inferior ST-elevation with reciprocal ST-changes and her troponin I rose to 4.18 μg/L, prompting urgent coronar...

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Section: Discussionmentioning

confidence: 97%

Infectious Aortitis

2016

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“…In the current case, a definitive diagnosis was not obtained before surgery, and infection with typical organisms, such as Salmonella species or Staphylococcus aureus, was favored based on our previous experience. In addition, in a past case report, the rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm was documented on transesophageal echocardiography within six days (12).…”

Section: Discussionmentioning

confidence: 98%

A Rare but Potentially Lethal Case of Tuberculous Aortic Aneurysm Presenting with Repeated Attacks of Abdominal Pain

et al. 2015

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Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.

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“…Nonetheless, if the trachea is interposed, upper ascending aorta and proximal aortic arch locations may be missed. 1,2,9,10 Computed tomography scan (CT) with contrast enhancement is widely available in most medical centers being considered by many the initial imaging technique of choice. 2,4 It allows a rapid exclusion of other aortic pathologies that may sometimes resemble acute aortitis, such as aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer.…”

Section: Diagnosismentioning

confidence: 99%

“…If surgery is not emergent (patients without impending aortic rupture or uncontrolled sepsis), it seems reasonable to perform a course of antibiotics for 2 to 4 weeks prior to surgery to improve local surgical conditions. 9 The antimicrobial therapy should be extended for at least 6 to 12 weeks after surgical excision and clearance of blood cultures. A longer course should be considered for immunosuppressed patients and if biochemical parameters of inflammation do not return to normal.…”

Section: Management and Treatmentmentioning

confidence: 99%

“…4 Furthermore, there are only a few cases in the literature describing IA in the absence of an aneurysm or rupture. 3,5,6,7 Infectious thoracic aortitis has a male predominance (male:female ratio = 3:1) and the mean age at diagnosis is 65 years old. If IA occurs associated to an IE, there is no gender predominance and the mean age at diagnosis is 40 years old.…”

Section: Introductionmentioning

confidence: 99%

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Infectious Thoracic Aortitis: A Literature Review

Lopes

Almeida

Dias

et al. 2009

Clinical Cardiology

169

200

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Infectious thoracic aortitis (IA) remains a rare disease, especially after the appearance of antibiotics. However, if left untreated it is always lethal. It usually affects patients with atherosclerotic aortic disease and/or infective endocarditis. Mycotic aneurysm is the most common form of presentation, although a few reports of nonaneurysmal infectious thoracic aortitis have also been described. Various microorganisms have been associated with infectious thoracic aortitis, most commonly Staphylococcal, Enterococcus, Streptococcus, and Salmonella species. It is extremely important to establish an early diagnosis of IA, because this condition is potentially life‐threatening. However, diagnosis is frequently delayed since clinical manifestations are usually nonspecific. Antibiotherapy in combination with complete surgical excision of the infected aorta is the best choice of treatment. Copyright © 2009 Wiley Periodicals, Inc.

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Rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm documented by transesophageal echocardiography

Cited by 27 publications

References 14 publications

Infectious Aortitis

Infectious Aortitis

A Rare but Potentially Lethal Case of Tuberculous Aortic Aneurysm Presenting with Repeated Attacks of Abdominal Pain

Infectious Thoracic Aortitis: A Literature Review

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