Infectious aneurysms are almost invariably of bacterial origin. It is a rare life-threatening disease, with a mortality reaching 67% in the absence of an early treatment (1), due to hemorrhage and uncontrolled sepsis.Clinical and biological findings are not specific and the diagnostic is often delayed. In the presence of fever and sepsis, CT is the imaging method of choice as several features may indicate the infectious origin and distinguish from atherosclerotic aneurysms. Case reportA 55-year-old woman was admitted in our institution because of fever and abdominal pain.Upon admission, she presented with tachycardia (110 bpm) and slightly decreased blood pressure (110/70 mmHg). Infection of the lower urinary tract was suspected at first. Blood tests showed an important inflammatory syndrome with increased C-reactive protein (CRP) levels (34 mg/dL, normal: < 1 mg/dL). However, urine analysis did not disclose any abnormal findings. A CT-scan of the whole abdomen was performed (Fig. 1).CT revealed an important infiltration of the retroperitoneal fat surrounding the distal part of the abdominal aorta as well as the proximal portion of the right iliac artery. The density of the infiltrated fat was evaluated at 20 HU, which was hardly compatible with blood. The infiltration also involved the pelvic retroperitoneal space. After contrast artery and measured 44 x 31 mm in axial view. Based on these clinical and radiological findings, the diagnosis of infected aneurysm of the right iliac artery was rendered. The patient was surgically treated 3 days after admission. She is alive and doing well 2 years after the operation. injection (Fig. 2), CT demonstrated a large aneurysm that was located in the proximal part of the right iliac JBR-BTR, 2012, 95: 350-354. MYCOTIC ANEURYSM OF THE RIGHT ILIAC ARTERY: IMAGING DIAGNOSIS AND CORRELATION WITH PATHOLOGICAL FINDINGSG
Dear editor, we read with great interest the two recent case reports about pneumomediastinum: "Compli cated pulmonary interstitial emphysema" reported by C. Altay (JBR-BTR, 2011, 94: 84) and "Spontaneous soccer-induced pneumomediastinum in a 39-year-old man" reported by K. De Smet (JBR-BTR, 2011, 346-347). We would like to widen this subject, reporting a case of massive spontaneous pneumomediastinum by Macklin effect in a 25-year-old man. High quality MDCT series, associated to scientific literature review, allow us to highlight the the CT appearance of the Macklin effect leads us to affirm the spontaneous orgin of the pneumomediastinum and thus permitting to be reassuring.Our patient, a previously healthy 25-year-old man, entered the hospital complaining of acute retrosternal and endoscopy of the upper airways were performed and were normal. The patient was treated with 48-hour medical observation. During that time, clinical manifestations were resolved and radiographic signs of conditions disappeared.Spontaneous pneumomediastinum (SP) is defined as the nontraumatic presence of free air in the mediastinum of a patient with no known underlying disease. It is a probably underestimated condition that has been observed to occur in young adults.According to scientific literature (1-4), the clinical presentation of SP in the majority of the cases associated with acute retrosternal chest pain (60 to 70%), coughing (25 to 40%), shortness of breath (25 to 67%) and subcutaneous emphysema (40 to 80%) at the physical examination. Dysphagia and neck pain are also pain which worsened with deep breathing and shortness of breath. Cardio-pulmonary examination, blood test and electrocardiogram were reassuring.Chest radiography revealed pneumomediastinum with gas collection dissecting the tissues of the neck (Fig. 1). A computed tomography (CT-scan) was performed and massive pneumomediastinum was confirmed, along with subcutaneous emphysema and a small left pneumothorax ( Fig. 2-3). There was no pleural effusion. We also detected some free air collection along the segmental and lobar bronchi and pulmonary arteries representing interstitial pulmonary emphysema. These CT features indicated the spontaneous origin of pneumomediastinum which in turn helped us to be reassuring in our approach. Nevertheless, an esophagoscopy JBR-BTR, 2012, 95: 98-100.
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