Mycotic aneurysm leading to iliac arteriovenous fistula diagnosed by vascular duplex color scan.

Abstract

Arteriovenous fistula between common iliac vessels is uncommon. Most of the reported cases are secondary to lumbar disc surgery. 1 Mycotic aneurysm of iliac vessels caused by bacterial infection is even rarer. We describe the case of a 63 year old man with dyspnea, abdominal pain, bipedal edema, chills and fever. He had a right common iliac AVF as a result of a ruptured salmonella mycotic aneurysm, and the diagnosis was made by vascular duplex color scan. CASE REPORTA 63 year old man came to our hospital with chief complaints of having had intermittent fever, chills, abdominal pain, exertional dyspnea, and bipedal edema for 1 month. He had history of alcohol abuse but no history of abdominal trauma or surgical operation. On admission, physical examination revealed an ill-appearing man with normal state of consciousness. His body temperature was 38.3°C. His blood pressure was 124/50 mm Hg, and his pulse was 100 beats/min, regular and bounding. Respirations were 28 per min, rapid and shallow. His skin was warm, with no cyanosis. Jugular venous pressure at a 45 degree sitting position was 15 cm with large V wave and Y descent. Cardiac examination revealed a pansystolic murmur at the left lower sternal border. A continuous bruit and thrill were noted at the lower abdominal area. Bipedal pitting edema was present, and the peripheral pulses were bounding. Laboratory data showed a white blood cell count of 14.6 × 103/liter with shift to the left and a hemoglobin content of 10.1 g/dl. The prothrombin time was 16.5 s and the International Normalized Ratio was 1.6. The blood urea nitrogen level was 40 mg/dl and creatinine concentration was 1.7 mg/dl. The results for the remaining serum chemistry tests were unremarkable. Electrocardiogram revealed sinus tachycardia; chest radiography showed mild cardiomegaly. Salmonella choleraesuis was isolated on blood culture. Two-dimensional echocardiography revealed a normal left ventricular chamber size and contractility. Severe tricuspid and moderate mitral regurgitation were present. Abdominal vascular sonography showed an aneurysm  1998 by the American Institute of Ultrasound in Medicine • J Ultrasound

Phlegmasia cerulea dolens as an initial manifestation of a fistula between a ruptured iliac artery aneurysm and the iliac vein

“…Magnetic resonance angiography is useful for diagnosis if time permits. A duplex color ultrasound scan can promptly detect an AVF without invasion 8 …”

Mycotic Aneurysms in the Abdominal Aorta and Iliac Arteries: CT‐based Grading and Correlation with Surgical Outcomes

“…Mycotic aneurysm with an arteriovenous fistula has also been described. Of the eight reported cases of infected aneurysms with arteriocaval fistula in the English literature, at least five (62.5 %) resulted in death postoperatively [5,[25][26][27][28]36]. Prior to the progression to exsanguinating hemorrhage (grade 4 aneurysm), the reciprocal infectious processes between mycotic aneurysms and contiguous retroperitoneal structures represent extensive retroperitoneal infection that poses high risks of surgical mortality.…”

“…Saccular outpouching was defined as the presence of arterial wall destruction with formation of an eccentric blind sac that is contiguous with the arterial lumen [13,[21][22][23]. Associated findings were also evaluated, including psoas muscle abscess [6,14,24], vertebral body destruction [10,13,14,24], arteriovenous fistula [25][26][27][28], massive perianeurysmal hematoma, and active extravasation [13,29].…”