Endothelial infection is a recognized complication of Salmonella bacteremia, especially in elderly patients with diabetes mellitus. Mycotic aneurysms usually involve the abdominal aorta and may involve the iliac arteries.1,2 The clinical presentation of mycotic aneurysm secondary to Salmonella is classic (fever, back pain, and/or abdominal pain) but nonspecific. Such aneurysms are associated with high morbidity and mortality. We present a case of aortic mycotic aneurysm due to Salmonella and outline the therapeutic options. Case ReportA 71-year-old man known to have coronary artery disease, diabetes mellitus and hypertension, was admitted for management of Salmonella bacteremia. A week prior to admission, the patient had developed fever, chills and rigors, and had been treated symptomatically. Blood cultures that were taken grew Salmonella non-typhi group D four days later, and oral azithromycin was prescribed. The patient continued to have fever and chills, and was hence admitted for further evaluation.On examination, his temperature was 38°C, and there was no palpable lymphadenopathy. Chest and heart examination was unremarkable and no murmur was detected. The abdomen was soft and lax with no palpable masses. Laboratory investigations revealed a WBC of 15x10 9 /L with 60% polymorphonuclear cells, hemoglobin of 7.44 mmol/L (12 g/dL), and platelets of 656x10 9 /L. ESR was 110 and C-reactive-protein (CRP) was 22.6. Initial blood cultures one week prior to admission and those on admission were positive for S. nontyphi group D. Ceftriaxone was started intravenously. The patient complained of back pain and continued to have a low-grade fever. MRI of the spine revealed spondylolithiasis at L5-S1 and a hemangioma at LI with no herniation of the disc. A bone scan was negative, however, gallium-67 scan revealed a focal area of accumulation of the radio-tracer at the region of L4-5 area. CT scan of the abdomen revealed an aneurysmal dilatation of the abdominal aorta, extending from below the origin of the renal arteries down to the iliac bifurcation. The aneurysm demonstrated an extraluminal leakage beyond the calcified wall (Figure 1). The patient underwent successful resection and grafting of the abdominal aortic aneurysm using a straight 14 mm Gore-Tex graft. Intraoperatively, the small bowel was adherent to the site of the aortic aneurysm and was technically difficult to separate from the aneurysm, hence the native aortic tissue was left in place. Intraoperative Gram's stain of the aneurysmal wall showed many WBCs but no organisms, and the cultures subsequently were negative. A repeat CT scan one week postoperatively showed no leak from the aorta. The CRP decreased to 12.6 and ESR to 64. The patient received IV ceftriaxone for a total of 38 days, and a two-month course of oral Ciprofloxacin. On follow-up, the CRP was <0.3 and ESR was 9. At one-year follow-up, the patient was asymptomatic with negative blood cultures and good anatomic results on CT scan. DiscussionIn 1885, Osier described mycotic aneurysm in associati...
Thyrocervical trunk aneurysms are very rare. Only a few cases have been reported in the literature. We present an interesting case of an eight-year-old boy who came to us with a right side neck pulsating mass which was painless. He had no history of direct trauma or catheterization, and no history of upper limb embolization or associated disease, i.e., vasculitis. There were no signs of brachial plexus compression. Case ReportAn eight-year-old boy was referred from another hospital with a two-month history of a mass in the right supraclavicular area which was gradually increasing in size (Figure 1). There was no history of trauma or catheterization, or family history of aneurysms or vasculitis diseases. He had had a CT scan in the local hospital and was diagnosed as a case of right subclavian artery aneurysm and referred for further management.Neck examination showed a right supraclavicular mass around 4 x 5 cm which was pulsating, firm, mobile and non-tender. There was no bruit and transillumination test was negative. Right upper limb pulses and neurological examination were normal. The rest of the vascular and physical examinations were normal. Ultrasound of the neck showed a mass measuring 5 x 3 x 3 cm. CT scan without contrast showed an aneurysm-like mass in the right supraclavicular area filled in by a large thrombus. The CT scan with contrast showed the mass again with evidence of enhancement (Figure 2). Doppler ultrasound showed a flow within the mass of undetermined origin. The patient had an aortic arch angiogram which showed no evidence of aneurysm in the right subclavian artery (Figure 3). The venogram was normal. A selective angiogram was repeated, and this showed that the aneurysm was supplied by a small branch of the thyrocervical trunk of the right side (Figure 4). This was selectively catheterized and embolized with coil. Almost complete obliteration of the flow was noted. A decision was then made to go for surgery through a right transverse incision, using the supraclavicular approach. A large aneurysm with a major feeder coming out of the thyrocervical trunk was double ligated and the whole aneurysm was excised. The patient did well and was discharged in good condition. Histopathology results revealed a pseudoaneurysm with an organized thrombus, without any evidence of inflammatory process or other pathological lesion. DiscussionAneurysms of the thyrocervical trunk are rare. There are only three reported cases in the English literature. One case presented with features of C8/TI root compression.1 Another case of aneurysm was reported with features of vocal cord paresis. A case of pseudoaneurysm of the thyrocervical trunk as a complication of failed internal jugular venous catheterization 2 has also been reported. The presentation in our patient was totally different from the previous reported cases. He presented with a painless mass which was gradually increasing in size. The most common cause of these aneurysms in young patients is a direct trauma or internal jugular venous catheterization. Ot...
G Khougeer, AHB Okda, Difficult Femoral Arteriovenous Fistula in a Child. 2000; 20(2): 150-152 An arteriovenous (AV) fistula is an abnormal communication between the arterial and venous systems, and can be congenital or acquired. The majority of peripheral fistulas are the result of trauma.1,2 The extent of clinical manifestations is related to the size, duration, and the precise location of the fistula, varying from local changes to central changes due to stress on the entire cardiovascular system. Chronic peripheral fistulas are typically associated with dilatation and elongation of the feeding artery, 4 as well as proximal dilatation of the venous system. Venous hypertension, valve incompetence, and venous hypertrophy commonly lead to distal swelling, dermatitis and ulceration, similar to that seen in the post-phlebitic state (Figure 1).Although physical diagnosis is easy when these fistulas are located in the extremities, arteriography is important in delineating the anatomy in order to plan the appropriate management of the patient. However, with the invasive techniques currently available, there should be few chronic traumatic AV fistulas in the practice of vascular surgery. 5 Case ReportA three-year-old girl presented with skin ulcer over the left lower leg, which had been debrided several times and skin grafted (Figure 1). The patient was the product of a 32-week gestation pregnancy, and was admitted to the nursery unit. She was diagnosed with left leg lymphangiectasia, based on previous clinical positive lymphangiography findings and recurrent cellulitis. During one of the debridement sessions of the leg ulcer, considerable bleeding occurred which required suturing. The suspicion of AV malformation was raised when MRI showed significant dilated vessels, both superficial and intramuscular. The patient was referred to the vascular surgery service.Physical examination showed an ill-looking child with low-grade fever, but normal cardiorespiratory system. Abdominal examination was also normal. The whole left lower limb was swollen (Figure 1). There was no sign of a previous injury in the left groin, but there was evidence of dermatitis and ulcer on the lower medial aspect of the leg. A thrill and murmur were elicited over the femoral vessels.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.