Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management

Abstract

Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.

A rare case of mycotic aortic aneurysm with Clostridium perfringens culture

“…11 Furthermore, aortic injury resulting from iatrogenic injuries during cardiothoracic surgeries, cardiac catheterization, and blunt or penetrating traumatic injury to the thoracic aorta can also contribute. 1 From the above-mentioned risk factors, our patient had diabetes and a history of episodic fever during the month prior to his last admission.…”

“…Mycotic aortic aneurysm (MAA) is a rare but lethal disease that can involve a localized or a large area and progress slowly or rapidly. 1 Mycotic thoracic aortic aneurysm (MTAA) is commonly caused by bacteria and rarely by fungi. Different mechanisms of seeding of the aortic wall by organisms include bacterial endocarditis emboli, contiguous extension of infection to the thoracic aorta, bacteremia or systemic sepsis, or direct introduction of bacteria into the wall of the artery due to trauma.…”

“…Mycotic aortic aneurysm (MAA) is a rare but lethal disease that can involve a localized or a large area and progress slowly or rapidly 1 . Mycotic thoracic aortic aneurysm (MTAA) is commonly caused by bacteria and rarely by fungi.…”

Acute‐onset dysphonia secondary to a ruptured mycotic aortic arch aneurysm: a rare case of Ortner syndrome

“…5 Mycotic aneurysms, which are aneurysmal dilations of the aorta secondary to an infection, account for only 0.6%-2.6% of the total aortic arch aneurysm cases in North America. 6 The definitive therapy in these cases is surgical management with complete excision of the infected segment of the aorta, while medical management may be supplementary. This case highlights the importance of a complete investigation, including laryngoscopy, of nonresolving dysphonia in elderly patients who have undergone conservative therapy.…”

“…Given the nonspecific presentation of mycotic aortic arch aneurysms and ruptures, it is critical to include these entities in the differential diagnosis for patients presenting with predisposing risk factors including atherosclerosis, immunosuppression or systemic infection. 6…”