Stephens Christopher T, Pounds Lori L, Killewich Lois A
Department of Anesthesiology, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555-0735, USA.
Angiology. 2006 Aug-Sep;57(4):506-12. doi: 10.1177/0003319706290739.
Infectious aortitis has become increasingly uncommon and, when diagnosed, typically occurs in an immunocompromised elderly male with a history of Staphylococcus or Salmonella infection and underlying atheromatous cardiovascular disease. The authors report a case of a 74-year-old man with aortitis complicated by rupture secondary to Staphylococcus aureus infection. The patient presented with worsening abdominal pain and fever after being discharged from the emergency room 2 weeks before with back pain and leukocytosis diagnosed as urinary tract infection and bronchitis. Computed tomography (CT) imaging of the retroperitoneum on the first visit appeared normal. Repeat CT scan on the subsequent visit revealed a contained rupture of a nonaneurysmal aorta at the level of the diaphragm. The patient was taken to the operating room emergently for repair. An infected periaortic hematoma and a 1 cm perforation in the posterior aorta were found. The aorta was excised and the area debrided. Revascularization was performed using a 22 mm extruded polytetrafluoroethylene (ePTFE) interposition graft placed in situ. This case demonstrates that a high index of suspicion is required in diagnosing infectious aortitis and that the diagnosis may be delayed in many cases. Additionally, it may not be uncommon for the infected aorta to rupture without prior aneurysm formation.
感染性主动脉炎已变得越来越少见，一旦确诊，通常发生在免疫功能低下的老年男性，他们有葡萄球菌或沙门氏菌感染史以及潜在的动脉粥样硬化性心血管疾病。作者报告了一例74岁男性，患有因金黄色葡萄球菌感染继发破裂的主动脉炎。该患者在2周前因背痛和白细胞增多被诊断为尿路感染和支气管炎而从急诊室出院后，出现腹痛加重和发热。首次就诊时腹膜后的计算机断层扫描（CT）成像显示正常。随后复诊时的重复CT扫描显示在膈肌水平有一个非动脉瘤性主动脉的局限性破裂。患者紧急被送往手术室进行修复。发现一个感染性主动脉周围血肿和主动脉后壁一个1厘米的穿孔。切除主动脉并对该区域进行清创。使用一个22毫米的原位植入的挤压聚四氟乙烯（ePTFE）人工血管进行血管重建。该病例表明，诊断感染性主动脉炎需要高度的怀疑指数，而且在许多情况下诊断可能会延迟。此外，感染的主动脉未经事先形成动脉瘤就破裂可能并不罕见。
