Dataset Information

Multifocal Mycotic Aneurysms and Pseudoaneurysms.

ABSTRACT: Mycotic aneurysms and pseudoaneurysms, though rare, present significant diagnostic and therapeutic challenges. The case follows a 74-year-old male with a history of bladder cancer who developed multifocal mycotic aneurysms and pseudoaneurysms following sepsis. Initially misdiagnosed as a Pancoast tumor, imaging revealed an extensive disease involving the right subclavian artery, proximal descending thoracic aorta, infrarenal abdominal aorta, and right common iliac artery. This case highlights the importance of considering mycotic aneurysms in the differential diagnosis of patients with a history of infection and highlights the role of Computed Tomography Angiography in early diagnosis.

SUBMITTER: Perdomo C

PROVIDER: S-EPMC11328734 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Multifocal Mycotic Aneurysms and Pseudoaneurysms.

Perdomo Camilo C Jaramillo Catalina C Ocacio Laura L Ferguson Emma E Ocazionez Daniel D

JACC. Case reports 20240807 15

Mycotic aneurysms and pseudoaneurysms, though rare, present significant diagnostic and therapeutic challenges. The case follows a 74-year-old male with a history of bladder cancer who developed multifocal mycotic aneurysms and pseudoaneurysms following sepsis. Initially misdiagnosed as a Pancoast tumor, imaging revealed an extensive disease involving the right subclavian artery, proximal descending thoracic aorta, infrarenal abdominal aorta, and right common iliac artery. This case highlights th ...[more]

PMID: 39157561

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Project description:Background/Objectives: Giant splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPs) represent rare conditions, characterized by a diameter greater than or equal to 5 cm. The risk of rupture is increased compared to common SAAs and SAPs, necessitating urgent treatments to prevent it. Methods: This systematic review was conducted through a comprehensive search involving the PubMed, Google Scholar, and Scopus databases. A total of 82 patients and 65 articles were included in the analysis. For each patient, we investigated age, sex, symptoms, comorbidities, the presence of a true or a false aneurysm, the dimensional criteria used to define dilations as giant aneurysms or pseudoaneurysms, the dimension of the two greatest diameters, imaging studies, surgical treatment, post-operative length of stay (LOS), and post-operative follow-up. Results: The results revealed a similar incidence in both genders (43 males vs. 39 females) with a median age of 55.79 years. The most frequently described symptom was pain (59.76%). Thirteen cases were false aneurysms and 69 were true aneurysms. The mean greatest diameter was 9.90 cm. The CT scan was the most utilized imaging study (80.49%). Open, endovascular, and hybrid surgery were performed in 47, 26, and 9 patients, respectively, with complication rates of 14.89%, 23.08%, and 22.22% occurring for each treatment. The post-operative LOS was 12.29 days, 2.36 days, and 5 days, respectively. The median follow-up was 17.28 months overall. No recanalization was observed after endovascular procedures during the follow-up period. Conclusions: The dimensional criterion to define SAAs and SAPs as giant was most frequently that at least one diameter was ≥ 5 cm. The CT scan was the most frequently utilized radiological study to diagnose giant SAAs and SAPs. Finally, endovascular procedures, open surgeries, and hybrid treatments presented similar post-operative complication rates. The post-operative LOS was lower for the endovascular group, and the follow-up period did not show aneurysm recanalization in any patients.

Project description:PurposeTo evaluate the diagnostic accuracy and specific imaging characteristics of positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (PET/CT), contrast enhanced CT (CE-CT), and a combined imaging approach (CE-PET/CT) in patients with infectious/mycotic (MAA), inflammatory (IAA), and non-infected, non-inflammatory abdominal aortic aneurysm (AAA).Materials and methodsIn this single-center retrospective cohort study, all imaging data sets of 29 consecutive patients with clinically suspected MAA or IAA were anonymised with different, reshuffled identification numbers and retrospectively and independently analysed by two experienced readers, blinded to all clinical patient data. Readers determined the presence or absence and MAA, IAA and AAA and of predefined imaging characteristics (e.g. fluid collection), and measured metabolic activity and wall thickness of all aneurysms. A multidisciplinary team of specialists served as standard of reference and re-evaluated every clinical case, considering all clinical, laboratory, microbiological, histopathological and imaging results, including all follow-up examinations.ResultsDiagnostic accuracy was higher in PET/CT as compared to CE-CT in differentiating AAA from MAA and IAA: area under the receiver operating characteristic curve (AUC-ROC) 0.81 (95% confidence intervals 0.69-0.92) and 0.63 (0.52-0.74) (P = 0.027). Specific imaging characteristics were significantly associated with different types of aneurysms (P<0.05), i.e. very high metabolic activity and dorsal sparing of metabolic activity in PET/CT and wall thickening in CE-CT were indicative for IAA; fat stranding and fluid collections in CE-CT were associated with MAA; while low metabolic acitivity and absence of wall thickening in PET/CT, and less fat stranding and absence of wall thickening in CE-CT were indicative for non-infected, non-inflammatory AAA.ConclusionSpecific imaging characteristics of PET/CT and CE-CT may be helpful in differentiating between MAA, IAA, and non-infected, non-inflammatory AAA.

Dataset Information

Multifocal Mycotic Aneurysms and Pseudoaneurysms.

Publications

Multifocal Mycotic Aneurysms and Pseudoaneurysms.

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