Endovascular Management of a Rare Case of Pediatric Vertebral Artery Mycotic Aneurysm: A Case Report

Abstract

Pediatric posterior-circulation aneurysms are uncommon, difficult-to-treat lesions associated with significant morbidity and mortality. Infections and trauma are important risk factors in children. Here, we present a 10-year-old boy with a lower respiratory tract infection, rapidly progressive right-neck swelling, and weakness of the right upper limb. Imaging revealed a partially thrombosed right vertebral-artery pseudoaneurysm with multiple cavitory lung lesions. Subsequent laboratory work-up showed underlying primary immunodeficiency disorder (chronic granulomatous disease). The aneurysm was successfully managed by parent-artery occlusion. The child made a complete recovery without neurological sequelae.

Infected popliteal pseudoaneurysm in a youth basketball player: A case report and brief review of the literature

“…In the pediatric population, vascular aneurysms are rare entities, even more so for infected aneurysms, which account for 15% of all pediatric aneurysms. 1 To our knowledge, this is the first pediatric case of an infected popliteal artery pseudoaneurysm reported in the literature. This condition is often referred to as mycotic pseudoaneurysm, but it is a misnomer considering that the pathogen is more often bacterial than fungal.…”

“…One case was a vertebral artery-infected pseudoaneurysm preceded by a lower tract respiratory infection. 1 That patient was also diagnosed with a chronic granulomatous disease, which could have caused vascular dilatation and bacteremic seeding according to the authors. That pseudoaneurysm was treated with endovascular coiling, considering the high risk of performing a surgical treatment in that anatomic location.…”

Endovascular Management of Internal Carotid Artery Pseudoaneurysm Secondary to Pediatric Deep Neck Space Infection: A Case Report and Review of Literature

“…These are more common in children as compared with adults due to higher incidence of deep neck space infections in this age group. 4 8 In a review by Ruff et al, only 31 pediatric cases of infectious pseudoaneurysms of extracranial carotid artery had been reported since 1968. 9 Common organisms associated with this complication are Staphylococcus aureus and Streptococcus pyogenes .…”

“…2 4 Patency of stents and flow diverters with long-term antiplatelet medication is not well evaluated in children, hence making them less preferable in children. 2 4 8 Bare metal stents, stent grafts, and flow diverters are not used in mycotic pseudoaneurysms, as they are prone to get infected and are not sufficient to prevent spread of septic emboli. In addition to lesion-specific management, the child should be kept on antimicrobial cover for 4 to 6 weeks.…”