HighlightsSuture granuloma is relatively rare.After tumor resection, positive PET/CT findings could indicate suture granuloma.Postoperative PET/CT surveillance might give false-positive findings.PET/CT cannot detect small peritoneal metastatic lesions.A surgical examination should be performed when metastases are suspected.
A 69-year-old man with a past history of asymptomatic abdominal aortic aneurysm developed pneumococcal meningitis. Antibiotic therapy improved his meningitis. However, he also developed vertebral osteomyelitis, iliopsoas abscess, and infected abdominal aortic aneurysm. The aneurysm was sequentially dilated, suggesting the impending rupture. An emergency open aneurysm repair using a tube homograft was performed. All of the vertebral osteomyelitis, iliopsoas abscess, and infected abdominal aortic aneurysm are rare complications. In particular, if a patient with bacterial meningitis has a preexisting aortic aneurysm, infected aortic aneurysm should be noted. To prevent the rupture of the aneurysm, the emergent vascular surgery including aorto-aortic homograft substitution should be considered.
Introduction
Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease, an autosomal dominant genetic disorder, is characterized by a café au lait spot and cutaneous neurofibromas. It typically involves the skin, nerves, bones, muscles, and eyes, and occasionally involves vascular complications and can lead to life-threatening hemorrhage.
Case presentation
We present the case of a 77-year-old female with a posterior tibial artery rupture with NF-1. She presented with sudden right lower leg swelling, pain, paresthesia, and paralysis; computed tomography images revealed popliteal artery aneurysm with surrounding hematoma, expanding from the posterior aspect of the knee to the calf. Diagnosed with compartment syndrome, due to a ruptured right popliteal artery aneurysm, she underwent prosthetic replacement of the popliteal aneurysm. Intraoperatively, the fragility of the popliteal artery was noted, although no perforation site was recognized despite the aneurysm; active bleeding originated from the hematoma between the calf muscles. Intraoperative digital subtraction angiography revealed an extravasation at the branch of the posterior tibial artery that was managed by coil embolization of the posterior tibial artery.
Clinical discussion
Although the frequency of NF-1 vasculopathy is unknown, vasculopathy is the second most common cause of mortality in patients with NF-1, after malignancy. The less invasive endovascular approach might be preferable for treating NF-1-related aneurysm. The NF-related vasculopathy lesion sites are diverse, and intraoperative angiography would help confirm the diagnosis.
Conclusion
NF-1-related vasculopathy may be associated with vascular fragility, and the endovascular approach might be preferable. Endovascular-first approach could have helped in correct diagnosis in the present case.
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