Aortites thoraciques infectieuses : implications microbiologiques, physiopathologiques et thérapeutiques

Early Diagnosis of Nonaneurysmal Infectious Thoracic Aortitis Using Transesophageal Echocardiogram in a Patient with Purulent Meningitis

“…Infectious thoracic aortitis (IA) is a rare entity in the antibiotic era and usually appears in patients with prior aortic disease and/or associated infective endocarditis [1, 2]. IA and mycotic aneurysms (MA) are different presentations of the same disease.…”

“…Various microorganisms have been associated with IA, most commonly Salmonella and Staphylococcal species, along with Streptococcus pneumonia . However, in up 25% of cases an etiologic agent is not found, maybe due to pretreatment with antibiotics, the absence of an infectious focus in the aortic lumen, or the presence of anaerobic microorganisms as causative agents of the infection [1, 2]. An early diagnosis of IA is very important because this condition is associated with a high rate of rupture and mortality [1].…”

“…The excised aortic segment showed only a mild inflammation of the aortic wall and an atheroma plaque with many fibrinous material attached, which means that perhaps medical treatment alone would be sufficient. Nevertheless, surgical resection was undertaken, preventing MA formation with subsequent rupture, based on the evidence that surgery combined with medical treatment has a much better prognosis (survival rate of 75%–100% versus 10% with medical treatment alone) [2, 10]. After surgery, antibiotherapy was not extended behind 4 weeks because the patient persistently had negative clinical and analytical signs of infection.…”

Aortite tropicale

“…Dilatation en kissing avec insufflation simultanée dans les deux branches de division fièvre ou de point d'appel infectieux, absence de maladie athéromateuse ou d'immunodépression [2], discrétion du syndrome inflammatoire biologique et caractère asymptomatique des anévrismes. Le jeune âge, le niveau d'atteinte aortique et la stabilité des lésions ne sont pas en faveur d'une origine syphilitique [2,3].…”

“…Dilatation en kissing avec insufflation simultanée dans les deux branches de division fièvre ou de point d'appel infectieux, absence de maladie athéromateuse ou d'immunodépression [2], discrétion du syndrome inflammatoire biologique et caractère asymptomatique des anévrismes. Le jeune âge, le niveau d'atteinte aortique et la stabilité des lésions ne sont pas en faveur d'une origine syphilitique [2,3]. Malgré l'IDR phlycténulaire et les séquelles pulmonaires, l'aortite tuberculeuse [2,4] est peu probable : l'anévrisme tuberculeux est isolé, de type sacciforme et sans calcifications pariétales, souvent secondaire à un foyer de contiguïté dans un contexte de tuberculose disséminée.…”