Periaortic abscess

Case contributed by Assoc Prof Craig Hacking

Presentation

Embolic cerebral and cerebellar infarcts. Previous bioprosthetic AVR and aortic root repair for infective endocarditis. Echocardiography shows possible collection adjacent to aortic root.

Patient Data

Age: 55 years
Gender: Male

ECG-gated CTA

CT

ECG-gated CT aortogram. Previous surgical replacement of the aortic valve, aortic root and ascending aorta. The aortic anastomosis appears unremarkable. A rind of ill-defined soft tissue attenuating material surrounds the aortic graft, measuring approximately 81 x 60 mm in maximal oblique axial dimensions and has increased in maximal depth new compared to a previous CTPA. No convincing evidence of contrast extravasation. No gas is demonstrated within the the collection. The aortic valve appears well seated. The proximal coronaries are patent. Three-vessel configuration of the aortic arch, the supra-aortic branches are patent.

Small pericardial effusion. Calcified coronary atheroma involving the right coronary and left anterior descending coronary arteries. A possible filling defect is noted at the ostium of the left atrial appendage, raising the possibility of thrombus.

Left-sided PICC line, the tip is located at the proximal IVC.

Borderline enlarged right pretracheal lymph nodes, measuring 11 mm, most likely reactive.

Bibasal compressive atelectasis and subsegmental right middle lobe compressive atelectasis. Small bilateral pleural effusions.

Impression

Surgical replacement of the aortic valve, aortic root and ascending aorta. Hypoattenuating periaortic collection has increased in size when compared to the recent CT pulmonary angiogram, and would be keeping with periaortic abscess as shown on the recent TOE. No evidence of contrast extravasation.

Case Discussion

The patient proceeded to theater for sternotomy where purulent material was drained from around the root graft and non coronary cusp. The prosthetic aortic valve was removed and revision root repair and AVR performed.

Operative specimen grew Staphylococcus aureus.

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