Rapidly Progressing Aneurysm of Infected Thoracic Aorta with Pseudoaneurysm Formation

Abstract

A 60-year-old man presented with chest discomfort with fever and high C-reactive protein (CRP). Chest computed tomography (CT) disclosed a mediastinal soft tissue swelling originating from the aortic arch, and gallium-67 single-photon emission CT revealed intense uptake in the same region. We initially suspected mediastinitis and/or a thoracic aortic infection. Antibiotics improved his symptoms and CRP levels. However, a follow-up CT scan 33 days later, revealed an aortic arch aneurysm and the patient was diagnosed with infective aortic aneurysm. Here, we report a rare case of a rapidly progressing aneurysm of infected aorta aortic infection with pseudoaneurysm formation.

Unusual course of an abdominal aortic aneurysm in a patient treated with chemotherapy for gastric cancer

“…2,3 Also, a rapid complete aneurysm sac retraction over the course of only a few weeks is very uncommon. 4,5 Rapid aneurysm expansion was described in single case reports for mycotic 6,7 or inflammatory AAAs, 8 and for a patient who received chemotherapy with gemcitabine, cisplatinum, and corticosteroids. 9 The etiology of the AAA in this patient remains unclear.…”

Imaging Features and Diagnosis of Infected Aortic Aneurysms and Inflammatory Diseases Involving the Aorta

“…The mortality rate of infected aneurysm is higher than that of non-infected aneurysm [2], especially without appropriate treatments [10,11]. A rapidly progressive clinical course and changes in imaging findings are also useful in the diagnosis, with the time course varying from days [12] to months [11,13]. The next step in diagnosing an infected aneurysm is based on identifying the infection-causing organisms and imaging features.…”

“…Atherosclerotic findings can help clinicians differentiate infected aneurysms from other inflammatory aortic diseases, and periaortic fluid or air collection may indicate bacterial involvements [9,[21][22][23]]. An aorta with bacterial infection may appear to be normal in size and to have a thickened aortic wall, with mild contrast enhancement in the initial evaluation [11,12]. Serial CE-CT scans can visualize the extension or dilatation of the diseased area and thus contribute to the effectiveness of therapy [11][12][13].…”

“…An aorta with bacterial infection may appear to be normal in size and to have a thickened aortic wall, with mild contrast enhancement in the initial evaluation [11,12]. Serial CE-CT scans can visualize the extension or dilatation of the diseased area and thus contribute to the effectiveness of therapy [11][12][13]. However, CT imaging cannot clearly differentiate an infection from an inflammation, because the inflammatory aortic disease coincidentally occurs in an atherosclerotic lesion.…”

Mycotic Aneurysm Mimicking Atheroma in Aortic Arch

“…Computed tomography angiography (CTA) was done 2 months after the PET study and disclosed the presence of a 3.4 cm aortic aneurysm with periaortic fluid, which was compatible with a mycotic aneurysm ( Picture 2 , white arrow). A mycotic aneurysm in the aortic arch is a rare, but life-threatening development ( 1 ). 18F-FDG PET is sensitive and reproducible for delineating vascular inflammation (e.g., vasculitis and atherosclerosis) ( 2 ), and it can also detect infected aortic aneurysms.…”