Mycotic femoral artery aneurysm

Case contributed by Prof Oliver Hennessy

Presentation

Groin swelling of sudden onset. Patient is septic

Patient Data

Age: 78
Gender: Male
Modality: CT

There is a 6.3 cm x 4.8 cm x 6.7 cm complex pseudoaneurysm of the left common femoral artery at the level of origin of the profunda. The neck of the pseudoaneurysm measures 1cm. The pseudoaneurysm is surrounded by haematoma measuring up to 2.5 cm in thickness with evidence of haematoma tracking to skin.

The common femoral artery and proximal superficial femoral artery are narrowed by 50% immediately proximal and distal to the pseudoaneurysm origin respectively. The profunda femoris is patent and enhances normally. The superficial femoral artery distally is patent and enhances normally. There is marked left thigh swelling. The aorta and major branches, external and internal iliac arteries are patent with mild diffuse mixed soft and calcific plaque disease. On the right, common femoral, profunda, superficial femoral arteries are patent.

Conclusion:

6.7cm left CFA pseudoaneurysm with 1 cm neck, opposite profunda origin.

Case Discussion

The patient had no history of arterial intervention or IVDU (most common cause of mycotic aneurysm at this site). He went on to have arterial reconstruction. 

Histology

MICROSCOPIC DESCRIPTION:

Sections of the lymph node show atrophy with dropout of lymphoid follicles, being replaced by fibrosis and fat. The remaining lymphoid follicles are mostly primary in type. Very occasional secondary follicles with small germinal centres are noted. The lymphoid cells appear uniform, though they are small in size with no nuclear atypia. The interfollicular zone contains increased numbers of plasma cells, along with some neutrophils. No Dutcher bodies are noted. There is normal distribution of B and T-lymphocytes. The CD23+ follicular dendritic cell network is intact. The kappa and lambda CISH shows no evidence of light chain restriction. No increased numbers of IgG4 cells are seen. The spirochaete immunostain is negative. There is no evidence of lymphoma. 2. Sections of the artery show marked intimal and medial hypertrophy with fibrosis and dystrophic calcification. Some parts of the vessel wall are disrupted and attenuated. There is abundant surrounding inflammatory exudate with fibrin and neutrophils. No granulomas are seen. The Gram stain shows many clumps of Gram positive bacterial cocci. The Grocott stain shows no fungi.

DIAGNOSIS:

  1. Lymph node: Fibrosed and atrophic lymph node with active chronic inflammation. No evidence of malignancy.
  2. Left femoral artery wall: Disruption with acute inflammation and bacteria, consistent with an infection.
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Case Information

rID: 33709
Case created: 21st Jan 2015
Last edited: 12th Jan 2017
System: Vascular
Inclusion in quiz mode: Included

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