Infectious aortitis with mycotic pseudoaneurysm

Case contributed by Michael P. Hartung
Diagnosis certain

Presentation

Abdominal pain, fever, leukocytosis.

Patient Data

Age: 65 years
Gender: Male
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Sagittal C+ portal
venous phase
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Info

Heavy atherosclerosis of the abdominal aorta, mesenteric, and iliac vessels. Hazy stranding and mildly prominent lymph nodes about the abdominal aorta at the level of and slightly inferior to the renal arteries. No definite periaortic gas is identified. No aortoenteric fistula. 

Posterior projecting  small pseudoaneurysm at the level of the right renal artery, with the defect in the wall measuring 6-7 mm and the extraluminal collection measuring 2.1 x 0.8 x 1.2 cm.  Focal ectasia measuring 2.6 cm in the mid segment of the infrarenal abdominal aorta
without aneurysm. 

Severe narrowing and heavy plaque at the origin of the right renal artery. Ill-defined rounded area of low attenuation along the anterior interpolar cortex which could represent small area of inflammation, infarction, or mass.

Colonic dilation with large amount of stool.

Case Discussion

Laboratory values:

  • WBC 24k 

  • Lactate 13

  • Blood cultures positive for MRSA 

Infectious aortitis with small pseudoaneurysm. The periaortic stranding, adenopathy, and history of fever with leukocytosis should lead to very high suspicion for this diagnosis. The pseudoaneurysm is likely mycotic in origin.

Attempt at cadaveric repair was unsuccessful due to irreversible coagulopathy, eventually resulting in the patient's demise.

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